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Glyceryl trinitrate relieved the patient's symptoms, suggesting coronary spastic angina (CSA). We report the first case of CSA after IVIg. Practitioners should be aware of the potential risks of CSA when administering IVIg for MG patients, in particular in old patients with vascular risk factors. We report the first case of CSA after IVIg. Practitioners should be aware of the potential risks of CSA when administering IVIg for MG patients, in particular in old patients with vascular risk factors. Esophageal tuberculosis