Utility of Breath-Holding Time in Monitoring Acute Neuromuscular Respiratory Failure in Bulbar-Onset Myasthenia Gravis: A Case Report.

We report the management of a 64-year-old male with newly diagnosed bulbar-onset myasthenia gravis (MG) who was hospitalized with acute neuromuscular respiratory insufficiency. This case highlights the challenges in monitoring respiratory function in MG patients, especially in the presence of bulbar and nuchal weakness, and emphasizes the potential utility of single breath-hold time (SBHT) over forced vital capacity (FVC) as a reliable bedside monitoring tool. Despite initial stabilization with intravenous immunoglobulin (IVIG), the patient deteriorated, requiring escalation to the intensive care unit (ICU), and the clinical worsening corresponded with the SBHT rather than with FVC.