Fatigability – long-lasting disease difficult to treat

Fatigability is an abnormal decrease in muscle strength with a negative impact on the patient's quality of life and socio-professional activity. Since it is a feature of modern society, the doctor must determine whether the patient's condition is the result of physical or intellectual exertion. The approach is complex and requires a multidisciplinary collaboration between the internist, psychologist, psychiatrist, neurologist, rheumatologist, endocrinologist and the infectious disease doctor. We present the case of a 22-year-old female patient who underwent multiple medical examinations for 6 months and whose main symptom was fatigability. The female patient went to the neurology practice where speech and swallowing disorders were found, palpebral ptosis with intermittent diplopia, accentuated by exertion. The female patient performed brain magnetic resonance imaging (MRI) - within normal limits. Electromyography (EMG) - 10% decrease. Histopathological examination of the thymus revealed thymic tissue showing histopathological lesions of thymic lymphocytic hyperplasia. One month after the confirmation of the diagnosis of myasthenia gravis and after the histopathological test result, laparoscopic thymectomy was performed by a left transpleural approach with a favourable postoperative evolution. The patient was subsequently treated with Medrol and Mestinon. In the past, myasthenia gravis was associated with high mortality, and now the long-term prognosis has changed and life expectancy is approaching normal limits.