Atypical Myasthenia gravis in an older person resulting in delayed diagnosis: a case report

Myasthenia gravis (MG) is a rare autoimmune neuromuscular disorder characterised by varying degrees of skeletal muscle weakness. Diagnosing MG represents a challenge for clinicians due to the diversity of disease manifestations. We present an unusual case of this disease in an older gentleman in which the patient reported swollen tongue and lips which was incorrectly diagnosed and treated as angioedema. Months later, he developed progressive dysphagia, dysarthria and weight loss. The diagnosis was further delayed by the identification of a hiatal hernia and Zenker's diverticulum after extensive investigation for dysphagia. A total of 15 months on prompted by persistent symptoms, the patient was found to have MG by positive antibody test and Electromyogram. Treatment was initiated which led to a rapid and significant relief of his symptoms.