DOI: 10.12890/2025_005386

Atypical bulbar myasthenia gravis in an elderly male unmasked by levofloxacin: a diagnostic challenge

Authors

  • Mrudula Thiriveedi Department of Internal Medicine, Decatur Morgan Hospital, Decatur, USA
  • Anil Chimakurthy Department of Neurology, Decatur Morgan Hospital, Decatur, USA
  • Siddharth Patel Department of Internal Medicine, Decatur Morgan Hospital, Decatur, USA
  • Sujatha Baddam Department of Internal Medicine, Huntsville Hospital, Huntsville, USA
  • Rafik ElBeblawy Department of Internal Medicine, Decatur Morgan Hospital, Decatur, USA
  • Punuru J. Reddy Department of Internal Medicine, Decatur Morgan Hospital, Decatur, USA

drmrudula.giridhar@gmail.com

Keywords

Myasthenia gravis, bulbar symptoms, acetylcholine receptor antibodies, levofloxacin, elderly, autoimmune neuromuscular disorder

Abstract

Background: Myasthenia gravis (MG) is an autoimmune neuromuscular disorder that typically presents with ocular symptoms. Isolated bulbar symptoms, such as dysphagia and dysarthria, are rare, and most commonly seen in men with late-onset MG. We report one such rare case of MG in an 82-year-old male presenting with progressive bulbar weakness, seemingly triggered by levofloxacin use.
Case Report: An 82-year-old male with multiple comorbidities presented with progressive weakness, dysphagia, and drooling following levofloxacin therapy. Examination revealed neck drop, weak lower facial muscles, and dysarthria. Initial neuroimaging and labs were inconclusive. Neurology initiated pyridostigmine with rapid improvement. Elevated acetylcholine receptor antibodies confirmed MG. He was started on efgartigimod alfa in the outpatient setting with improvement in MG composite scores.
Conclusions: Atypical bulbar MG can mimic other neurologic disorders and is prone to delayed diagnosis, especially in the elderly. Clinicians should maintain a high index of suspicion, particularly when symptoms worsen after medication exposures like fluoroquinolones. Early diagnosis and appropriate treatment can significantly improve outcomes and quality of life.

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Chest X-ray on admission showing left lower lobe pneumonia

Published

2025-04-23

Issue

Vol. 12 No. 5 (2025)

Categories

How to Cite

1.
Thiriveedi M, Chimakurthy A, Patel S, Baddam S, ElBeblawy R, Reddy PJ. Atypical bulbar myasthenia gravis in an elderly male unmasked by levofloxacin: a diagnostic challenge. EJCRIM [Internet]. 2025 Apr. 23 [cited 2026 Nov. 3];12(5). Available from: https://ejcrim.com/index.php/ejcrim/article/view/5386

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