Abstract

Aim: To emphasize upon diagnostic difficulties in Juvenile ocular myasthenia gravis (JOMG). Methods : A study series of three pediatric cases with variable clinical manifestations but negative serology for JOMG. Results: Through this case series we report three children with double seronegative ocular myasthenia gravis. Ptosis was predominant symptom of first case but strabismus remained the principal presenting complain in second and third case. Third case was falsely operated for alternating exotropia and later presented with recurrence and ptosis. Clinical diagnosis of JOMG was made when symptoms improved with pyridostigmine stimulation test. Treatment given with oral pyridostigmine at a dose of 0.5 mg/kg/dose every 6 hours showed a good response and maintenance. Conclusion- Double seronegative subtypes need a high index of suspicion as these children need to be initiated on appropriate treatment early to avoid generalization and long-term physical morbidity.

Full Text