Multidisciplinary treatment of chronic intestinal pseudo obstruction in myasthenia gravis

Introduction: Myasthenia gravis (MG) is a complex B cell-mediated autoimmune neuromuscular disorder where acetylcholine receptor dysfunction leads to increased muscle weakness and fatigability. MG is often accompanied by comorbidities that are difficult to manage due to drug-drug and drug-disease interactions. MG patients benefit from a multidisciplinary approach to optimize treatment and prevent polypharmacy. There are a few case reports available, however none report the management of polypharmacy, migraine, and chronic intestinal pseudo obstruction (CIP) in a pediatric patient. Methods: We report the case of the multidisciplinary management of a 19-year-old female with a complex past medical history including MG, chronic migraines, CIP, gastroesophageal reflux disease (GERD), asthma, sleep apnea, and anemia during the COVID-19 pandemic. Results: Our case demonstrated the effectiveness of joining various disciplines together to deliver patient care with the use of technology. Our patient was admitted on a failed regimen of 18 medications and was discharged home on an effective regimen of 13 medications. Conclusion: Our medical team worked together to treat her MG, chronic migraines, bacteremia, and CIP resulting in a reduction of polypharmacy.