Myasthenia gravis (MG) is an autoimmune condition affecting the neuromuscular junction. Juvenile MG (JMG) is a subtype of pediatric MG and is reported to be a rare neurological disorder with variable presentation and difficult diagnosis. MG has been described as a great neurological mimicker having resemblance with a wide spectrum of neurological disorders. The present case is a distinctive and compelling example of JMG that manifested at a young age with a disguised presentation. Bilateral ptosis was the principal presenting symptom with mild facial droop which simulated Bell’s palsy initially. The patient was finally diagnosed as JMG based on acetylcholine receptor antibody test along with ophthalmological, electrophysiological, and imaging findings. She was managed for JMG and concurrent hyperthyroidism and is being regularly monitored for the effectiveness of the treatment. This report highlights the relevance of extensive clinical history, meticulous clinical examination, and awareness of similar neurologic disorders with overlapping characteristics in order to facilitate correct diagnosis, appropriate management, and effective treatment of this condition, often described as the “great imitator.”
Gupta et al. (2025) studied this question.