We report the development of acute respiratoiy failure in a myasthenic patient who was on immunosuppressive treatment. The patient was hospitalized due to myasthenic crisis provoked by listeria meningoencephalitis. He had to be intubated and mechanical ventilation was started due to acute hypercapnic respiratory failure. The patient could not be weaned from the ventilator despite intravenous immunoglobulin treatment and treatment for listeria infection. After 8 courses of plasmapheresis, he recovered and was successfully weaned from the ventilator.