To the Editor: Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission [
1]. MG in association with HIV infection is rare [
4]. We discuss a 5-y-old girl with perinatally acquired HIV infection developing MG, and highlight challenges faced in her management. A 5-y-old girl presented with history of bilateral fluctuating ptosis from five months. Consultation was sought after she developed dysarthria, dysphagia, and bulbar weakness for the past 2 wk. Other than myasthenia she was asymptomatic and was not on combination antiretroviral therapy (cART). On examination she had bilateral ptosis, external ophthalmoplegia, bulbar and proximal muscle weakness. In view of her oculo-bulbar symptoms, the differentials considered were, myasthenia gravis, or a space occupying or inflammatory lesion of the brain stem. The repetitive nerve stimulation test (RNST) at 3 Hz frequency at left abductor digiti minimi showed a decrimental response of 31% (Fig.
1, normal <10%). She...
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RS, NS: Conception and design of the study; RS, NS, DS, AG: Acquisition and analysis of data; RS, NS: Drafting the manuscript; PS: Overall clinical in-charge, approval for publication and will act as guarantor for the paper; JNG: Patient management, literature review and preparation of draft manuscript. All authors read and approved the final manuscript.