Introduction D.G. is a 79-year-old Caucasian male. He is a retired educator who taught political science and law at the high school level. The patient presented with a three-week history of slurred speech and some difficulty completing his weekday golf game. He was concerned that after a few minutes of talking, he sounded like Elmer Fudd and his “wascally wabbit” pattern of speech. D.G. was also worried about his ability to give a talk at his local church within the coming weeks due to the worsening dysarthria. He also complained about some difficulty closing his lips fully and reported dribbling when brushing his teeth. Upon physical examination by his family physician, he noted some weakness of the eye while mouth closure was strong. There was no external ophthalmoplegia — eye movements were normal and there was no ptosis. However, there was some fatigability of the proximal limb muscles, deltoids, and hip flexors. Due to the symptoms, he was concerned that this could possibly be Myasthenia Gravis (MG), especially with the dysarthria that came with prolonged speech. D.G. was referred to a neurologist who ordered labs, including an Acetylcholine receptor panel for diagnosis. Discussion Neuromuscular junction disorders can be genetic, such as congenital myasthenic syndromes, or caused by external toxins like botulinum toxin and curare. Others are acquired autoimmune conditions, including MG, Lambert-Eaton myasthenic syndrome (LEMS), and neuromyotonia.1 MG is the most common neuromuscular disorder and presents primarily with muscle weakness and fatigue.4 It is an autoimmune, B-cell-mediated disease in which antibodies attack key proteins, such as acetylcholine receptors (AChR), muscle-specific kinase (MuSK), LRP4, agrin, titin, and ryanodine.1 Due to its clear mechanism and location of action, Myasthenia Gravis is not only a prototype for autoimmune diseases but also a valuable model for understanding synaptic function. MG is categorized into subtypes based on clinical features and antibody profiles, including early-onset MG, late-onset MG, thymoma-associated MG, MuSK, LRP4, seronegative, and ocular MG.1 Although it is a rare disease, the number of Myasthenia Gravis cases has been rising over the past two decades, particularly among the elderly. This increase is likely due to improved availability of antibody testing and a growing aging population.5 It affects individuals of all ages, sexes, and ethnic backgrounds, though it is most commonly seen in young adult women under the age of 40 and older men over the age of 60.3 Despite its prevalence across various populations, Myasthenia Gravis is neither inherited nor contagious, although in rare cases, more than one member of a family may be affected. A Less Common Presentation of Myasthenia Gravis By Kody Korth, Pre-Med Student at Weber State University, and Johnnie Cook, MD, Family Physician at Tanner Clinic The “Elmer Fudd Syndrome” 22
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