Anti ACh Receptor Ab Positive late-onset Bulbar Myasthenia Gravis – Predominantly presented as Laryngeal Myasthenia

Abstract

Though the report of late onset myasthenia gravis is seen frequently in literature, isolated bulbar myasthenia in elderly age group is rarely found. Moreover, dysphonia as an initial manifestation of bulbar myasthenia has not been emphasized in late-onset MG. Here we report an elderly man who presented with bulbar symptoms in whom diagnosis was made with clinical clues as well as serological test like anti acetylcholine receptor (AChR) antibody. A high index of suspicion is required to exclude other common causes of acute bulbar weakness like stroke, demyelinating neurological diseases, toxicity, infection and other causes. This case illustrates one of the uncommon presentations of late-onset MG.