(A715) Dysphonia as the main symptom in Myasthenia Gravis, a case report.

Introduction: A case report, demonstrating the importance of the differential diagnosis of Myasthenia Gravis in dysphonia.

Methods: Patient admitted on 10/01/2024 to the emergency department of the Hospital das Forças Armadas presenting dyspnea on medium exertion associated with a secretive cough, dysphonia and progressive dysphagia that began 6 months ago, initially for solids and, later, for liquids. During hospitalization in the Intensive Care Unit, an Otorhinolaryngology evaluation was requested on 10/03/2024 and videolaryngoscopy was performed, with a diagnosis of unilateral paralysis of the vocal cords (left vocal cord in adduction and right vocal cord in a paramedian position), with reduction of the cleft glottic and therefore airway protection suggested. The patient developed hyporexia, fatigue and difficulty walking due to progressive loss of strength in the lower limbs, in addition to dyspnea on minimal exertion, with video laryngoscopy on 10/14/2024 showing paralysis of the vocal folds in a bilateral paramedian position, with compromised light. of the trachea. Diagnostic hypotheses included myasthenia gravis, degenerative neuromuscular diseases, and motor neuron lesions. The decision was made to start empirical treatment with pyridostigmine, resulting in significant clinical improvement, including the removal of the nasoenteral tube and the start of an exclusive oral diet, in addition to a significant improvement in speech. Visualized by videolaryngoscopy on 11/01/2024, laryngeal anatomo-functional improvement, with mobility present and vocal folds with slight hypotonia.

Results: Empirical treatment with pyridostigmine was initiated, resulting in significant clinical improvement. A follow-up videolaryngoscopy showed anatomical and functional improvement of the larynx, with present mobility and mildly hypotonic vocal folds.

Conclusions: Given the negative impact of this pathology on the patient's quality of life, its suspicion during clinical investigation in patients with signs and symptoms in our specialty is of fundamental importance.