Disclosures: Andrea E. Dockry, MD: No financial relationships or conflicts of interest

Case Description: The patient presented to our inpatient rehab after a fall resulting in T12 burst fracture managed non-operatively. She was diagnosed with dysphagia secondary to esophageal dysmotility requiring gastrostomy tube. Modified barium swallow revealed penetration with thin and nectar consistencies and aspiration of thin and possibly nectar thick barium with varying maneuvers. Inpatient myasthenia panel was negative. Speech therapy worked on right side-lying and Masako exercises without improvement in dysphagia. Follow up esophageal and pharyngeal manometry revealed esophageal dysmotility and pharyngeal weakness. Myopathic panel, AChR Ab and MuSK Ab were negative. EMG/NCS of lower limb, including repetitive nerve stimulation of face and needle exam of proximal arm muscles and tongue was normal.

Setting: Tertiary care hospital.

Patient: A 71 year old female with history of cold agglutinin hemolytic anemia, autoimmune hepatitis, hypothyroidism, GERD, Sjogren’s Disease, chronic dysphagia, and osteoporosis Assessment/

Results: She re-presented to Neurology Clinic several months later with new onset hypophonia. Single fiber EMG performed was diagnostic of MG. She started IVIG with improvement in dysphagia.

Discussion: MG presenting as dysphagia is more common in elderly patients, and is the only symptom in 15% of patients(1,2).

Conclusion: MG must remain on the differential for patients presenting with dysphagia, as 15% of patient of generalized and 50% with ocular forms of MG are negative for AchR and MuSK Ab (3). Early diagnosis results in improved outcomes. 1. Klair JS, Rochlani YM, Meena NK. Myasthenia gravis masquerading as dysphagia: unveiled by magnesium infusion. Case Reports. 2014;2014(apr17 1). doi:10.1136/bcr-2014-204163. 2. Sanders DB, Howard JF. Disorders of neuromuscular transmission. In: Bradley WG, Daroff RB, Fenichel GM, et al., editors. eds. Neurology in clinical practice. vol 2 1st edn Massachusetts: Butterworth, Heinemann, 1991:1819 3. Cortés-Vicente E, Gallardo E, Martínez MÁ, et al. Clinical Characteristics of Patients With Double-Seronegative Myasthenia Gravis and Antibodies to Cortactin. JAMA Neurology. 2016;73(9):1099. doi:10.1001/jamaneurol.2016.2032.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/double-seronegative-myasthenia-gravis-mg-in-a-patient-presenting-with-chronic-dysphagia-a-case-report/