Progressive Bulbar Weakness in an Older Male With Suspected Double-Seronegative Myasthenia Gravis Culminating in Myasthenic Crisis: A Case Report.

Myasthenia gravis is a rare autoimmune disorder affecting the neuromuscular junction, causing muscle weakness that worsens with use and improves with rest. While it is typically diagnosed through antibody tests or electrophysiological testing, a smaller subset of the population is seronegative or may have inconclusive electrophysiological results. In emergent presentations, seronegative myasthenia gravis is a challenge to diagnose clinically, making it imperative to identify it early to ensure proper management and treatment. Here, we present the case of an older male with a complex medical history and suspected seronegative myasthenia gravis who through the course of his admission experienced myasthenic crisis necessitating treatment with both intravenous immunoglobulin and plasmapheresis.