Difficulties of diagnostic testing and therapy in seronegative myasthenia gravis with oculobulbar symptoms

The muscle-specific receptor tyrosine kinase (MuSK) antibody (ab) positive myasthenia gravis is a distinctive subgroup of the myasthenia gravis population. The clinical features are very variable with mostly severe oculobulbar involvement. The following case report should illustrate the complexity of diagnostic testing and therapy in this rarely subgroup of myasthenia gravis. A 69 year old female patient suffered from bulbar symptoms as dysarthria and dysphagia since 2 weeks. The patient developed ocular symptoms as left sided ptosis, horizontal and vertical double vision. The bulbar weakness got worse with dysa…