Question

A 35-year-old man has experienced increasing muscular weakness over the past 5 months. This weakness is most pronounced in muscles that are used extensively, such as the levator palpebrae of the eyelids, causing him to have difficulty with vision by the end of the day. After a night’s sleep, his symptoms have lessened. On physical examination, he is afebrile. No skin rashes are noted. Muscle strength is 5/5 initially but diminishes with repetitive movement. A CT scan of his chest shows thymic enlargement

Answer 1

In the given case, the patient is showing symptoms of muscle weakness and ptosis of eyelids, also there is history of thymic enlargement.

Looking at the given symptoms, it looks to be a case of Myasthenia gravis

Also Lambert Eaton syndrome can be a differential diagnosis.

Myasthenia gravis is an autoimmune disorder in which auto antibodies are produced against the Acetylcholine receptors over post synaptic terminals of muscle fibers. As a result the amount of ACH release is normal but it doesn't get used and leads to muscle weakness.

Thymoma and other autoimmune disorder are also linked with Myasthenia gravis.