A RARE CAUSE OF BREATHLESSNESS.

Myasthenia gravis is an established autoimmune disease commonly affecting middle aged female populations . Mediated by a type-II antibody reaction in which antibodies directed against post-synaptic nicotinic acetylcholine receptors attack the myoneural junction and damage the post-synaptic membrane via complement xation. This results in the failure of action potential propagation across the neurons, eventually leading to a neuromuscular weakness .Classically, the anticholinergic autoantibodies target the extraocular muscles, leading to uctuating muscular fatigability, predominantly resulting in bilateral diplopia and ptosis, which is typically worse at the end of the day. Breathlessness as a result of diaphragmatic palsy has been rarely described as the initial complaint.