Document Type : Case Report


1 Neuroscience Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.

2 Department of neurology, Kermanshah University of Medical Sciences, Kermanshah, Iran.

3 Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran


Background: Myasthenia gravis (MG) is a rare neuromuscular disorder resulting from the destruction of acetylcholine receptors at the neuromuscular junction by IgG antibodies. Although dysphagia is a common symptom in generalized form of MG, it is rarely reported as a sole manifestation of the disease, specifically in younger patients. Herein, we report a middle-aged adult patient with dysphagia as the sole manifestation of MG.
Case presentation: A 49-year-old male complaining of severe dysphagia underwent an extensive clinical and paraclinical examination. Oropharyngeal dysphagia was confirmed by an experienced speech-language pathologist using the water swallowing test. Unilateral right paresis of the soft palate and vocal fold was confirmed using laryngeal video stroboscopy. Chest computerized tomography (CT) scan, brain Magnetic resonance imaging (MRI), and routine blood, urine, and thyroid tests were normal. In electromyography, slow repetitive nerve stimulation (RNS) showed a decremental response in the right nasalis muscle. The diagnostic neostigmine test with 1.5 mg of intramuscular neostigmine led to significant recovery of laryngeal and pharyngeal motor dysfunction and dysphagia within 12 hours, so the MG diagnosis was confirmed. The patient was treated with plasmapheresis, pyridostigmine, and prednisolone, which followed an improving course and led to better swallowing of solid and liquid foods.
Conclusion: MG should be considered as a diagnosis in middle-aged adults with complaints of dysphagia.


  1. Ramalho S, Pereira S, Oliveira P, Morais H, Lima N, Condé A. Dysphagia as a presenting symptom of myasthenia gravis—case report. Otolaryngol Head Neck Surg. 2014; 3(1):23-5.
  2. McIntyre K, McVaugh-Smock S, Mourad O. An adult patient with new-onset dysphagia. CMAJ. 2006;175(10):1203. 
  3. Gilhus NE, Verschuuren JJ. Myasthenia gravis: subgroup classification and therapeutic strategies. Lancet Neurol. 2015;14(10):1023-36.
  4. Llabrés M, Molina-Martinez FJ, Miralles F. Dysphagia as the sole manifestation of myasthenia gravis. J Neurol Neurosurg Psychiatry 2005;76(9):1297-300. doi: 10.1136/jnnp.2004.038430.
  5. Klair JS, Rochlani YM, Meena NK. Myasthenia gravis masquerading as dysphagia: unveiled by magnesium infusion. BMJ Case Rep. 2014;2014:bcr2014204163. doi: 10.1136/bcr-2014-204163. PubMed PMID: 24744075.
  6. Haryono A, Budiarti R. Dysphagia as presenting symptom of myasthenia gravis: a case series of successful outcome in multidisciplinary approach. J Med Sci. (Berkala ilmu Kedokteran). 2020;52(3): 282-91.