Myasthenia Gravis with Features Resembling Muscular Dystrophy

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Abstract
The case history of a 38-year-old woman with a life-long illness of neuromuscular disorder is presented. The presence of muscular dystrophy was suggested by muscle biopsy, creatinuria and the distribution of muscular weakness, most pronounced in the shoulder and pelvic girdles, resulting in a waddling gait and marked lordosis. Features not typical of muscular dystrophy were the absence of marked wasting of contractures, ophthalmoplegia from the onset and the preservation of tendon reflexes. Pharmacologic tests with tensilon, neostigmine and tubocurare established the presence of myasthenia gravis. The possible importance of myopathy (rather than a defect of neuromuscular transmission) in the pathogenesis of some cases of myasthenia is discussed.