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- Kensaku Yanai, Sunao Takahashi, Itsuki Soejima, Ayako Oniki, Toshiya Matsuda, Shoichiro Ishihara, Osamu Higuchi, and Hiroyuki Tomimitsu.
- Department of Neurology, JA Toride Medical Center, Japan.
- Intern. Med. 2024 Jun 20.
AbstractAn 86-year-old woman was admitted to our hospital with cryptogenic progressive dyspnea and dysphagia following a tracheostomy procedure 4 months prior to presentation. She exhibited fluctuating diplopia, bilateral vocal fold paralysis, normal nerve test results, negative findings for serum anti-acetylcholine receptor and anti-muscle-specific kinase antibodies, and positive findings for anti-LDL-receptor related protein 4 (LRP4). A videofluoroscopic swallowing study (VFSS) with edrophonium revealed an improvement in bulbar paralysis. Consequently, the patient was diagnosed with double-seronegative myasthenia gravis (DSN-MG) and began immunomodulatory therapy. This case emphasizes the diagnostic challenges of bulbar-type DSN-MG and underscores the value of a VFSS with edrophonium for diagnosing this condition.
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