• 1 Hospital Seri Manjung, Department of Internal Medicine, Perak, Malaysia.
  • 2 Hospital Seri Manjung, Department of Internal Medicine, Perak, Malaysia
  • 3 Hospital Raja Permaisuri Bainun, Neurology Unit, Perak, Malaysia
  • 4 Hospital Raja Permaisuri Bainun, Department of Respiratory Medicine, Perak, Malaysia
  • 5 Hospital Raja Permaisuri Bainun, Department of Radiology, Perak, Malaysia
Med J Malaysia, 2020 05;75(3):295-297.
PMID: 32467548


Recurrent pneumonia warrants a diligent work-up to identify the underlying cause that perpetuates the disease process. Insidious bulbar dysfunction is arguably the most devastating as it would be diagnosed late after significant pulmonary complications due to chronic micro-aspiration. Bulbar disorder should be considered as the potential aetiology of recurrent pulmonary infections in the young population after excluding immunodeficiency disorder and respiratory anatomical anomaly. This report illustrates a rare case of bulbar onset myasthenia gravis which manifested as focal bronchiolectasis due to recurrent undiagnosed aspiration pneumonia three years earlier. Absence of hallmark features of Myasthenia Gravis (MG) such as ptosis, opthalmoplegia and proximal muscle weakness contributed to the diagnostic delay and challenges in this case. The diagnosis was established with the collaboration of multidisciplinary teams. Subsequent correct therapeutic interventions resulted in remarkable recovery in functional status and prevented her from further aspiration in the long run.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.