Atypical bulbar myasthenia gravis in an elderly male unmasked by levofloxacin: a diagnostic challenge
Background: Myasthenia gravis (MG) is an autoimmune neuromuscular disorder that typically presents with ocular symptoms. Isolated bulbar symptoms, such as dysphagia and dysarthria, are rare, and most commonly seen in men with late-onset MG. We report one such rare case of MG in an 82-year-old male p...
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SMC MEDIA SRL
2025-04-01
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| Series: | European Journal of Case Reports in Internal Medicine |
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| Online Access: | https://www.ejcrim.com/index.php/EJCRIM/article/view/5386 |
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| author | Mrudula Thiriveedi Anil Chimakurthy Siddharth Patel Sujatha Baddam Rafik ElBeblawy Punuru J. Reddy |
| author_facet | Mrudula Thiriveedi Anil Chimakurthy Siddharth Patel Sujatha Baddam Rafik ElBeblawy Punuru J. Reddy |
| author_sort | Mrudula Thiriveedi |
| collection | DOAJ |
| description | Background: Myasthenia gravis (MG) is an autoimmune neuromuscular disorder that typically presents with ocular symptoms. Isolated bulbar symptoms, such as dysphagia and dysarthria, are rare, and most commonly seen in men with late-onset MG. We report one such rare case of MG in an 82-year-old male presenting with progressive bulbar weakness, seemingly triggered by levofloxacin use.
Case Report: An 82-year-old male with multiple comorbidities presented with progressive weakness, dysphagia, and drooling following levofloxacin therapy. Examination revealed neck drop, weak lower facial muscles, and dysarthria. Initial neuroimaging and labs were inconclusive. Neurology initiated pyridostigmine with rapid improvement. Elevated acetylcholine receptor antibodies confirmed MG. He was started on efgartigimod alfa in the outpatient setting with improvement in MG composite scores.
Conclusions: Atypical bulbar MG can mimic other neurologic disorders and is prone to delayed diagnosis, especially in the elderly. Clinicians should maintain a high index of suspicion, particularly when symptoms worsen after medication exposures like fluoroquinolones. Early diagnosis and appropriate treatment can significantly improve outcomes and quality of life. |
| format | Article |
| id | doaj-art-67f0e792c71b4d53a9c444c69ebfbef4 |
| institution | DOAJ |
| issn | 2284-2594 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | SMC MEDIA SRL |
| record_format | Article |
| series | European Journal of Case Reports in Internal Medicine |
| spelling | doaj-art-67f0e792c71b4d53a9c444c69ebfbef42025-08-20T03:11:25ZengSMC MEDIA SRLEuropean Journal of Case Reports in Internal Medicine2284-25942025-04-0110.12890/2025_0053864921Atypical bulbar myasthenia gravis in an elderly male unmasked by levofloxacin: a diagnostic challengeMrudula Thiriveedi0Anil Chimakurthy1Siddharth Patel2Sujatha Baddam3Rafik ElBeblawy4Punuru J. Reddy5Department of Internal Medicine, Decatur Morgan Hospital, Decatur, USADepartment of Neurology, Decatur Morgan Hospital, Decatur, USADepartment of Internal Medicine, Decatur Morgan Hospital, Decatur, USADepartment of Internal Medicine, Huntsville Hospital, Huntsville, USADepartment of Internal Medicine, Decatur Morgan Hospital, Decatur, USADepartment of Internal Medicine, Decatur Morgan Hospital, Decatur, USABackground: Myasthenia gravis (MG) is an autoimmune neuromuscular disorder that typically presents with ocular symptoms. Isolated bulbar symptoms, such as dysphagia and dysarthria, are rare, and most commonly seen in men with late-onset MG. We report one such rare case of MG in an 82-year-old male presenting with progressive bulbar weakness, seemingly triggered by levofloxacin use. Case Report: An 82-year-old male with multiple comorbidities presented with progressive weakness, dysphagia, and drooling following levofloxacin therapy. Examination revealed neck drop, weak lower facial muscles, and dysarthria. Initial neuroimaging and labs were inconclusive. Neurology initiated pyridostigmine with rapid improvement. Elevated acetylcholine receptor antibodies confirmed MG. He was started on efgartigimod alfa in the outpatient setting with improvement in MG composite scores. Conclusions: Atypical bulbar MG can mimic other neurologic disorders and is prone to delayed diagnosis, especially in the elderly. Clinicians should maintain a high index of suspicion, particularly when symptoms worsen after medication exposures like fluoroquinolones. Early diagnosis and appropriate treatment can significantly improve outcomes and quality of life.https://www.ejcrim.com/index.php/EJCRIM/article/view/5386myasthenia gravisbulbar symptomsacetylcholine receptor antibodieslevofloxacinelderlyautoimmune neuromuscular disorder |
| spellingShingle | Mrudula Thiriveedi Anil Chimakurthy Siddharth Patel Sujatha Baddam Rafik ElBeblawy Punuru J. Reddy Atypical bulbar myasthenia gravis in an elderly male unmasked by levofloxacin: a diagnostic challenge European Journal of Case Reports in Internal Medicine myasthenia gravis bulbar symptoms acetylcholine receptor antibodies levofloxacin elderly autoimmune neuromuscular disorder |
| title | Atypical bulbar myasthenia gravis in an elderly male unmasked by levofloxacin: a diagnostic challenge |
| title_full | Atypical bulbar myasthenia gravis in an elderly male unmasked by levofloxacin: a diagnostic challenge |
| title_fullStr | Atypical bulbar myasthenia gravis in an elderly male unmasked by levofloxacin: a diagnostic challenge |
| title_full_unstemmed | Atypical bulbar myasthenia gravis in an elderly male unmasked by levofloxacin: a diagnostic challenge |
| title_short | Atypical bulbar myasthenia gravis in an elderly male unmasked by levofloxacin: a diagnostic challenge |
| title_sort | atypical bulbar myasthenia gravis in an elderly male unmasked by levofloxacin a diagnostic challenge |
| topic | myasthenia gravis bulbar symptoms acetylcholine receptor antibodies levofloxacin elderly autoimmune neuromuscular disorder |
| url | https://www.ejcrim.com/index.php/EJCRIM/article/view/5386 |
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