A 62-year-old woman is evaluated in the emergency department for a 2-week history of progressive shortness of breath, which has culminated over the past 3 days in a change in the sound of her speech and occasional swallowing difficulties. She says that approximately 8 weeks ago, she began to have blurred vision late in the day, particularly when driving home from work, and occasional weakness in the upper and lower limbs. Three weeks ago, she had a urinary tract infection treated with ciprofloxacin. The patient takes no other medications On physical examination, blood pressure is 118/56 mm Hg, pulse rate is 68/min, respiration rate is 22/min, and arterial oxygen saturation on ambient air is 98%. Her lungs are clear to auscultation. She has moderate bilateral proximal weakness in the upper and lower limbs, with mild weakness distally. Deep tendon reflexes are normal, and there is no appendicular or truncal ataxia. She has fluctuating ptosis and diminished facial strength. Speech is nasal and slurred; her language is normal. Which of the following is the best treatment option for this patient? A Plasma exchange B Prednisone C Pyridostigmine D Repeat ciprofloxacin therapy
Posted on: Thu, 27 Jun 2013 04:41:08 +0000
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