Over the past several years,
tacrolimus has attracted attention as a new therapeutic
drug for
myasthenia gravis (MG), but few reports have considered its use for MG in pediatric patients, and most of these have focused on severe systemic MG. In this case report, we used
tacrolimus to successfully treat a 13-year-old boy with ocular MG who had suffered from severe
steroid complications, including a failure of thrive and
osteoporosis. He first showed symptoms of ocular MG at age 2 years 3 months. At age 13 years, he was receiving PSL (3.75 mg/day), but the symptoms of ocular MG recurred. We increased the dosage of oral PSL up to 30 mg/day, and three courses of mPSL pulse
therapy were applied, but these
therapies had only limited effect, and his symptoms worsened.
Tacrolimus was started at 0.4 mg/day (0.011 mg/kg/day), and every 2 weeks the dose was gradually increased by 0.2 mg/day. His symptoms of MG began to improve 3 weeks after the initial administration of
tacrolimus. Approximately 3 months after the start of
tacrolimus administration, PSL was discontinued. Currently, at 1 year and 4 months after the start of
tacrolimus administration, while slight ptosis is observed in the evening, it does not influence his daily life, and his condition remains comparable to that when he stopped taking PSL. No adverse effects of
tacrolimus have been recognized. In pediatric patients with
steroid-dependent ocular MG without
thymectomy,
tacrolimus may be a safe and effective alternative to
steroid and
thymectomy.