Autoimmune disorder of NMJ acetylcholine receptors causing fatigable weakness, ptosis, diplopia.
History taking
- • Onset, duration, progression, severity
- • Aggravating / relieving factors
- • Past history, drugs, allergies, comorbidities
- • Family & social history relevant to presentation
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Myasthenic crisis: respiratory failure → ICU
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • Anti-AChR, anti-MuSK antibodies
- • Repetitive nerve stimulation / single-fibre EMG
- • CT chest for thymoma
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • Pyridostigmine 30–60 mg QDS
- • Prednisolone + steroid-sparing (azathioprine / MMF)
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
