When Weakness Persists Beyond Its Apparent Cause: A Case Report of Myasthenia Gravis.
- 1Internal Medicine, Gulab Devi Teaching Hospital, Lahore, PAK.
Abstract
Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction characterised by fluctuating, fatigable skeletal muscle weakness. Its overlap with reversible causes of weakness such as hypokalemia can easily delay recognition. We report the case of a 40-year-old man who presented with one week of profuse diarrhea and vomiting, along with two days of generalized limb weakness. Investigations revealed hypokalemia and hypomagnesemia, and his limb weakness partially improved after fluid and electrolyte correction, which raised suspicion of an additional underlying cause contributing to the persistent weakness. He was noted to have bilateral ptosis, and further history uncovered three months of fatigable weakness that worsened towards the end of the day, with slurred nasal speech, difficulty chewing, and nasal regurgitation. Examination showed a positive curtain sign, bilateral ptosis that improved with ice pack test, and fatigable proximal limb weakness with preserved reflexes. Anti-acetylcholine receptor antibodies were strongly positive, and contrast-enhanced computed tomography (CT) scan of the chest revealed the presence of thymoma in the anterior mediastinum. He responded well to pyridostigmine and oral prednisone. Thymectomy was subsequently planned. This case is a reminder that weakness outlasting its apparent cause warrants a neurological evaluation, since a concurrent electrolyte disturbance can readily mask an underlying myasthenic process.
Related
- C5-Predominant Segmental Zoster Paresis Presenting With Right Shoulder Abduction Weakness Before Cutaneous Eruption: A Case Report
- Depressive symptoms and fatigue are independently associated with myasthenia gravis-specific quality of life beyond neurological severity: a cross-sectional study
- Enteric Fever Presenting With Acute Bilateral Lower Limb Weakness due to Para Infectious Myopathy With Elevated Serum Creatine Kinase: A Case Report.
- Anesthetic Management of a Patient With Myasthenia Gravis Undergoing Thoracoscopic Thymectomy: A Case Report and Literature Review
- Suspected Bulbar-Predominant Myasthenia Gravis Exacerbation in an Older Adult With Respiratory Deterioration and Silent Aspiration: A Case Report
BibTeX
@article{ehsan2026when,
title = {{When Weakness Persists Beyond Its Apparent Cause: A Case Report of Myasthenia Gravis.}},
author = {Noor Ehsan and Hateem Ahmed and Mahnoor Iqbal and Maryam Arshad and Muhammad Imran},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116581},
url = {https://europepmc.org/article/MED/42903869},
note = {CC BY},
}
RIS
TY - JOUR
TI - When Weakness Persists Beyond Its Apparent Cause: A Case Report of Myasthenia Gravis.
AU - Noor Ehsan
AU - Hateem Ahmed
AU - Mahnoor Iqbal
AU - Maryam Arshad
AU - Muhammad Imran
PY - 2026
DA - 2026/09/20
JO - Cureus
DO - 10.7759/cureus.116581
UR - https://europepmc.org/article/MED/42903869
AB - Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction characterised by fluctuating, fatigable skeletal muscle weakness. Its overlap with reversible causes of weakness such as hypokalemia can easily delay recognition. We report the case of a 40-year-old man who presented with one week of profuse diarrhea and vomiting, along with two days of generalized limb weakness. Investigations revealed hypokalemia and hypomagnesemia, and his limb weakness partially improved after fluid and electrolyte correction, which raised suspicion of an additional underlying cause contributing to the persistent weakness. He was noted to have bilateral ptosis, and further history uncovered three months of fatigable weakness that worsened towards the end of the day, with slurred nasal speech, difficulty chewing, and nasal regurgitation. Examination showed a positive curtain sign, bilateral ptosis that improved with ice pack test, and fatigable proximal limb weakness with preserved reflexes. Anti-acetylcholine receptor antibodies were strongly positive, and contrast-enhanced computed tomography (CT) scan of the chest revealed the presence of thymoma in the anterior mediastinum. He responded well to pyridostigmine and oral prednisone. Thymectomy was subsequently planned. This case is a reminder that weakness outlasting its apparent cause warrants a neurological evaluation, since a concurrent electrolyte disturbance can readily mask an underlying myasthenic process.
SN - 2168-8184
ER -