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  1. "Mummy, my eyelids are heavy": A case series of juvenile myasthenia gravis
    Krishna L, Abdul Jalil NF, Lott PW, Singh S, Choo MM
    Eur J Ophthalmol, 2021 Mar;31(2):NP119-NP122.
    PMID: 31390886 DOI: 10.1177/1120672119867605
    PURPOSE: To report three cases of juvenile myasthenia gravis aged between 18 and 24 months with ocular symptoms as their first presentation.

    METHOD: A case series.

    RESULTS: We present a case series of juvenile myasthenia gravis in a tertiary centre in Malaysia. Two of the three cases consist of a pair of twins who presented with ptosis of bilateral eyes; the first twin presented 4 months later than the second twin. These two cases were positive for anti-acetylcholine receptor antibodies and had generalized myasthenia gravis, whereas the other case was negative for receptor antibodies and was purely ocular myasthenia gravis.

    CONCLUSION: Juvenile myasthenia gravis is relatively rare in toddlers. Early diagnosis and commencement of treatment is important to slow the progression of the disease and avoiding life-threatening events.

    Matched MeSH terms: Pyridostigmine Bromide/therapeutic use
  2. Fulltext Flaccid paralysis in an infant associated with a dirty wound and application of honey
    Joseph CJ, Khoo TB, Lee KY
    BMJ Case Rep, 2017 Jan 06;2017.
    PMID: 28062435 DOI: 10.1136/bcr-2016-218044
    An infant, who was born preterm at 36 weeks, presented with fever and ulcer at umbilical region which progressed to necrotising fasciitis of anterior abdominal wall. He was treated with intravenous penicillin, intravenous cloxacillin and local application of medicated honey. Subsequently, he required wound debridement. Postoperatively, he required prolonged invasive ventilation due to poor respiratory effort which was associated with hypotonia and areflexia. Nerve conduction study revealed absent responses. The diagnosis of infant botulism was made based on the clinical presentation, nerve conduction study and his clinical progress. Botulinum immunoglobulin was not available. He was treated with intravenous immunoglobulin and oral pyridostigmine. He was successfully extubated after 37 days, and currently the patient is doing well.
    Matched MeSH terms: Pyridostigmine Bromide/therapeutic use*
  3. Fulltext "Why do I always see double?" A misdiagnosed case of ocular myasthenia gravis for 10 years
    Yousuf UA, Yashodhara BM, Thanigasalam T, Ting HS
    BMJ Case Rep, 2014 May 02;2014.
    PMID: 24792021 DOI: 10.1136/bcr-2013-203488
    A 58-year-old man presented with diplopia and partial ptosis for 10 years. It was non-progressive in nature, despite inadequate medical attention the patient received from non-specialists/general practitioners. He did not have fatigability or diurnal variation in weakness and was clinically stable without exacerbations of disease for a decade. He did not have features of Graves's disease, oculopharyngeal dystrophy, cranial nerve paralysis, polymyositis and stroke. The possibility of an atypical presentation of myasthenia gravis (MG) was considered and the patient was evaluated. Ice pack test was negative, Cogan's lid twitch (CLT) test was positive and high titres of acetylcholine receptor antibodies (AChR Ab) suggestive of MG were found. He was treated accordingly with a very good response.
    Matched MeSH terms: Pyridostigmine Bromide/therapeutic use
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