A 40 year-old woman with AChR Ab-positive myasthenia gravis s/p thymectomy (two years prior) presents to the ED for dyspnea. At baseline, she takes azathioprine as well as pyridostigmine 30mg q4h while awake. She was formerly on scheduled outpatient IVIg, so she still as a port in place. About one week ago, she started having a non-productive cough and subjective fever. She went to urgent care, where she was prescribed amoxicillin. However, her symptoms have persisted, and she's more short of breath while completing her daily activities.
Initial vitals are notable for BP 117/56, HR 102, RR 15, SpO2 97% on 3L NC, and T 37.6C. Initial labs are notable for WBC 6.5, Hb 12.9, Plt 165, Na 139, K 4.7, Cl 110, HCO3 26, BUN 40, Cr 1.01, ABG 7.39/41/65/0.9. The ED consults you, querying whether she's having a myasthenia exacerbation.
The only thing that sticks out from her vitals is that she's requiring supplemental oxygen right now, but at least she's only on 3L via nasal cannula. Well, her respiratory rate is also a little quicker than usual (technically in the range of normal, but that's still actually fast). Her ABG shows some hypoxemia.
Her chest X-ray also looks pretty benign. There's no clear lobar consolidation. No interstitial markings. There's a normal gastric bubble. She also has a left chest port with tip terminating around the cavoatrial junction.
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