Seronegative Myasthenia Gravis Presenting as Dysphagia in a Young Male- A Diagnostic Dilemma

Abstract

21year old gentleman presented with insidious onset, gradually progressive dysphagia for 2 weeks. There was no other associated signs or symptoms. Initial blood workup, radiological investigations and diagnostic interventions were non-contributory. In the meantime, dysphagia worsened and was found to be progressive with advancement of the day. Oesophageal manometric studies showed gradual weakening of peristaltic contractions after a string of repetitive swallows. Repetitive nerve stimulation test and edrophonium test were suggestive of Myasthenia Gravis; Anti-acetylcholine receptor antibody and anti-MuSK antibody were negative. He was initiated on Pyridostigmine and had improvement of dysphagia after a few days. He has now achieved remission. Hence, we present a curious case of Seronegative Myasthenia Gravis in a young gentleman who presented with only dysphagia recovered with Pyridostigmine.