# Very Late-Onset Generalized Myasthenia Gravis Presenting With Worsening Frailty

## TL;DR

This paper presents a case of very late-onset myasthenia gravis in an elderly woman, highlighting the challenges of diagnosing and managing the condition in older adults.

## Contribution

The paper contributes a detailed case study emphasizing the importance of recognizing MG as a reversible cause of frailty in the elderly.

## Key findings

- The patient showed improvement with a combination of pyridostigmine, corticosteroids, and mycophenolate mofetil.
- Diagnosis was supported by clinical findings and confirmed with serological testing for acetylcholine receptor antibodies.
- The case underscores the need for careful evaluation of frailty in older adults to identify treatable conditions.

## Abstract

Very late-onset myasthenia gravis, defined as disease onset after 75 years of age, is a rare but increasingly recognized clinical entity due to population aging and improved access to diagnostics. We report the case of a woman who was in her 80s and presented with progressive fatigability, bulbar symptoms, and functional decline, initially misattributed to normal aging and degenerative conditions. Clinical examination revealed fluctuating ptosis and proximal muscle weakness, and bedside ice pack testing supported a diagnosis of myasthenia gravis (MG). Serological testing confirmed elevated acetylcholine receptor antibodies. She responded well to a combination of pyridostigmine, low-dose corticosteroids, and mycophenolate mofetil, with improvement tracked via the Quantitative Myasthenia Gravis (QMG) score. This case illustrates the diagnostic challenges of MG in older adults and emphasizes the importance of recognizing reversible causes of frailty. It also highlights the geriatric principle of aligning care with what matters most to the individual, preserving function, independence, and identity.