Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 1 2025 01 01 113 115 Hossein Karballaei Mirzahosseini School of Pharmacy, Semnan University of Medical Sciences, Semnan, Iran. Ehsan Yousefi-Mazhin Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Rezvan Hassanpour Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Atabak Najafi Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mahsa Tofighi-Mohammadi Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Sharifnia Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Amirmahdi Mojtahedzadeh Faculty of Medicine, Semmelweis University, Budapest, Hungary. Mojtaba Mojtahedzadeh Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. 2024 04 15 2024 04 20 Myasthenic crisis can affect the respiratory muscles in a life-limiting way that requires intubation and mechanical ventilation. This is a case report of a myasthenic crisis in a 61-year-old woman that became complicated following a lack of response to plasmapheresis, intravenous immunoglobulin (IVIG) therapy, and the development of septic shock. The co-occurrence of myasthenic crisis and sepsis is a challenging condition. Many antibiotics cause flare-ups of myasthenia gravis. Infection and sepsis can exacerbate myasthenia. We discuss the successful management of certain unique challenges. To treat sepsis, drugs that may cause deterioration of myasthenia gravis, such as amikacin, ciprofloxacin, colistin, vancomycin, amphotericin B, and voriconazole were prescribed, but eventually the sepsis was cured. After eradicating the infections and stabilizing the patient's hemodynamic, she received rituximab. After 3 weeks of treatment, she responded well to the rituximab, the respiratory failure recovered, and she was extubated and discharged from the ICU after 3 months of hospitalization. This report demonstrates that when the myasthenic patient is under mechanical ventilation, can use even cautionary drugs. https://aacc.tums.ac.ir/index.php/aacc/article/view/986