A Great Masquerader: Acute Respiratory Failure as the Only Initial Presentation for Juvenile Myasthenia Gravis

Myasthenia Gravis (MG) is most commonly caused by antibodies to acetylcholine receptor (AChRs). MG can present as respiratory failure during the late course of the disease, known as a myasthenia crisis. Mostly, this crisis develops in adult patients and associated with some intercurrent illness like infections. Sometimes, MG can present isolated respiratory failure as an initial presentation of disease, which was a rare presentation. This presentation will create diagnostic dilemmas among treating clinicians. Here, the present authors report a case of about an eight-year-old female with juvenile MG. She presented with isolated respiratory failure as her presenting manifestation. The child was diagnosed as MG based on history and electro-diagnostic tests. Child was recovered with supportive therapy, steroids and pyridostigmine. So, it is important to consider MG in cases of unexplained respiratory failure.