Dysphonia as first symptom of late-onset myasthenia gravis

Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction that causes muscle weakness and fatigue. Fluctuating fatigue of skeletal muscles is the key clinical feature. Late-onset MG is more frequent in elderly men and is often misdiagnosed. While involvement of oropharyngeal musculature has been described with symptoms of dysphagia and slurred speech, the presence of fluctuating dysphonia as the first symptom of late-onset MG has not been emphasized. The case of an elderly man, who demonstrated voice changes and later swallowing impairment with weight loss, is reported. This case presentation of late-onset MG emphasizes that this form of the disease should be considered in the differential diagnosis of acute onset dysphonia in elderly persons.