Post-malaria Myasthenia Gravis

Abstract

We report a nine-year-old girl who presented with complete drooping of the left eyelid and restriction of
medial gaze following an attack of febrile illness. The child was admitted into a rural hospital where she
was misdiagnosed and managed as a case of meningitis. She was referred to a tertiary children hospital
when her condition was not improving and where she developed the eye signs. She was diagnosed as a case
of severe malaria which responded well to quinine therapy. In our neurophysiology clinic, examination
revealed partial unilateral left eye ptosis, weak frontalis, neck flexors, fingers extensors & knee flexors.
Her investigations revealed positive neostigmine test, decremental response to repetitive nerve stimulation
(-15.6%,nasalis), increased jitter in single-fibre electromyography (left frontalis & extensor-digitorum
communis) and negative serology for myasthenia gravis antibodies. She showed remarkable improvement
after pyridostigmine therapy which continued for three months. Regular follow-up showed no recurrence
of her symptoms.