A Rare Presentation of a Rare Disease: Oropharyngeal Dysphagia as The Main Manifestation of Myasthenia Gravis

Abstract

Oropharyngeal dysphagia is defined as the inability or difficulty to initiate swallowing. It has a wide array of etiologies including structural and neurologic diseases. Myasthenia gravis (MG) is a rare autoimmune condition caused by antibodies against the post-synaptic membranes of the neuromuscular junction, leading to fatigable weakness of skeletal muscles. Bulbar symptoms are less prevalent than ocular symptoms or limb weakness but can be particularly morbid. Non-neurologists are more likely to be the first providers to evaluate patients with dysphagia and should be familiar with MG. We report a unique case of newly diagnosed MG with the initial presentation of solid food and liquid dysphagia.

Multiple Cranial Nerve Palsies in Otolaryngology Consultation: An Atypical Clinical Presentation Revealing Myasthenia Gravis

“…Myasthenia perfectly mimics otolaryngological pathologies because of its bulbar presentations [2]. ENT specialists are the first doctors to whom patients are referred at the onset of the disease because the symptoms include functional disorders of the cervicofacial sphere as described since 1979 by Carpenter et al [1], in this case, dysphagia [23] and dysphonia due to the pathological fatigability of the striated muscles of the pharynx and esophagus [2]. The dysarthria found by several authors as for our patient who presented an open rhinolalia or nasalization and a slowed vocal flow is due to an additional attack of the muscles of the tongue and the palate [2].…”

“…In Cameroon, as in most countries, the first-line treatment includes anticholinesterase drugs and corticosteroid therapy [5] [10] [23]. Our patient was put on this treatment based on pyridostigmine, which was replaced following a worsening of the signs by injectable corticosteroid therapy associated with azathioprine, a treatment on which the evolution was favorable.…”