• Takako Tachikawa, Shinichi Takeshima, and Nobuyuki Kawate.
• Department of Rehabilitation Medicine, Showa University School of Medicine, Kanagawa, Japan.
• Medicine (Baltimore). 2024 Jan 26; 103 (4): e36989e36989.

RationalePatients with elderly-onset myasthenia gravis can have a good prognosis with appropriate diagnosis and response, although it is difficult to differentiate between exacerbations of myasthenia gravis in elderly patients and age-related changes. Therefore, it is important for physicians to understand the clinical characteristics and safe assessment methods for patients with elderly-onset myasthenia gravis.Patient ConcernsAn 82-year-old male diagnosed with myasthenia gravis 6 months prior had no difficulty in daily living. After falling on a golf course, he was diagnosed with a right femoral neck fracture on the 1st day and underwent right total hip replacement surgery on the 12th day, being transferred to our hospital for rehabilitation therapy on the 32nd day. However, immediately after transfer, the patient showed fatigability during training and difficulty swallowing food.DiagnosesThis case was diagnosed as an exacerbation of myasthenia gravis.InterventionsPyridostigmine was initiated with the expectation of immediate effect on the 54th day.OutcomesHis symptoms and physical functions improved immediately, and walking distance and food intake increased. From this clinical course, it was judged that immunosuppressive therapy was indicated as a transition to generalized myasthenia gravis. For this reason, he was discharged after arranging postdischarge visits to the department of neurology, accordingly.LessonsA better understanding of the characteristics of elderly-onset myasthenia gravis may allow for relatively safe assessment of the condition and improve its diagnosis and treatment.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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