Unusual presentations of myasthenia gravis and misdiagnosis

Myasthenia gravis (MG) poses diagnostic challenges due to its diverse clinical presentations. Diagnosing MG remains complex despite advancements, necessitating further understanding of its diverse clinical profiles. We conducted a retrospective analysis of 290 MG cases. Patient demographics, symptomatology, and diagnostic outcomes were reviewed. Patients were categorized into two groups: those displaying classical presentations and those manifesting unusual presentations. The patients with unusual presentations were comprehensively evaluated and the demographic and clinical characteristics of the two groups were compared. In our study of 290 patients with MG, 20 presented with unusual manifestations (6.9%). These included isolated dropped head, bilateral facial weakness, distal limb weakness (e.g., foot and hand drop), weakness of limb-girdle muscles, and isolated ocular findings without ptosis. When patients were categorized into two groups based on their initial symptoms, no significant differences in demographic and clinical features were observed between the classical and unusual groups, except for a higher prevalence of anti-MuSK antibodies and more frequent administration of rituximab in patients with unusual presentations. Recognizing unusual MG presentations is crucial for timely management. Our study underscores the diverse clinical spectrum of MG, emphasizing the need for nuanced diagnostic approaches and prompt intervention.