MYASTHENIA GRAVIS PRESENTS AS BULBAR PALSY WITHOUT THYMOMA

Myasthenia gravis is the most common neuromuscular junction disorder associated with autoimmune diseases, although around 10-15% of patients have no detectable antibodies, and 85% of patients have antibodies. Bulbar symptoms are not commonly present in the early stages, although they often occur as the disease advances. We report 2 unique cases of myasthenia gravis manifesting as isolated bulbar palsy. The first case involves a 56-year-old male patient with a history of diabetes mellitus presenting with the early onset of bulbar palsy in the course of myasthenia gravis. The second case features a patient diagnosed with rheumatoid arthritis, presenting symptoms of speech and swallowing difficulties alongside joint pain, without the usual muscle weakness associated with myasthenia gravis. Prompt assessment is emphasized in this case study, even when faced with challenges in diagnosing MG due to the lack of general weakness with ocular symptoms, which ultimately increases the patient's chances of survival.