A detailed description of the patient’s history, including treatments and outcomes, are presented in Figures 1 and 2 . Briefly, in 2004, a 77-year-old male was diagnosed with seropositive gMG with primary bulbar symptoms without thymoma. Therapy was initiated with prednisolone 40 mg, azathioprine 150 mg, and pyridostigmine 60 mg 4-6 times daily and the patient was stable for 12 months thereafter before experiencing his first myasthenic crisis (Figure 1 ). This first myasthenic crisis was acutely treated with plasmapheresis, followed by more prednisolone, azathioprine, and pyridostigmine (Figure 1 ). Over the next 10 years, the patient experienced several more myasthenic crises, which were treated similarly with varying responses (mostly with minimal success and in some cases worsening of MG) (Figure 1 ). In 2015, the patient received his first monoclonal antibody therapy (rituximab) without clinical improvement (Figure 1 ). In 2017, the patient discontinued azathioprine due to squamous cell carcinoma on the back of both hands, and azathioprine was replaced by mycophenolate mofetil (a different immunosuppressant) (Figure 1 ). Despite a rigorous treatment regimen, the patient continued to experience recurring myasthenic crises, prompting immunoadsorption every 2-4 weeks (Figure 1 ), with limited success.