Myasthenia Gravis With Chronic Kidney Disease: A Diagnostic Challenge

The coexistence of myasthenia gravis (MG) and chronic kidney disease (CKD) presents a diagnostic challenge due to overlapping clinical features. MG is an autoimmune neuromuscular junction disorder, whereas CKD exhibits the gradual loss of kidney function. We report a 65-year-old male with long-standing CKD who developed progressive neuromuscular symptoms, including bilateral ptosis and bulbar involvement. His anti-acetylcholine receptor antibodies were negative; however, electrophysiological studies demonstrated a significant decremental response (> 10%) on repetitive nerve stimulation, supporting the diagnosis of MG. The patient required hemodialysis for worsening renal function and was treated with pyridostigmine for MG symptoms, resulting in clinical improvement. This case emphasizes the importance of distinguishing MG from CKD-related symptoms, particularly in seronegative patients, and highlights the need for careful clinical and electrophysiological evaluation.