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Myasthenia gravis has been reported to be associated with both ulcerative colitis (UC) and Crohn's disease (CD). 1- 3 The link between inflammatory bowel disease (IBD) and myasthenia gravis (MG) is thought to be related to the production of autoantibodies. 1 Myasthenia gravis is also associated with other autoimmune diseases including alopecia, lichen planus, vitiligo, and systemic lupus erythematosus. 4
Similarly, IBD frequently presents with other autoimmune disorders. One study demonstrated a 9.4% prevalence of autoimmune disorders in patients with UC including sclerosing cholangitis, thyroid disorders, vitiligo, insulin dependent diabetes mellitus, thyroid disease, pernicious anaemia, scleroderma, and seropositive rheumatoid arthritis. 4, 5 Despite the association between MG and other autoimmune disorders, there are relatively few reports of ocular findings as the presenting sign of MG in patients with IBD.
Case report
A 21 year old African-American male, with a medical history of biopsy proved ulcerative colitis diagnosed in 1995, focal segmental glomerular sclerosis determined by renal biopsy in 1995, and primary sclerosing cholangitis determined by liver biopsy in 2000 presented to the neuro-ophthalmology service with complaints of binocular diplopia and ptosis of the left upper eyelid. Both the diplopia and the ptosis were better in the morning and worsened during the course of the day. His ulcerative colitis had been in remission for the past 5 years without medication.
Best corrected visual acuity was 20/25 in each eye. The external examination revealed ptosis of the left upper eyelid that worsened in sustained upgaze. He had limited extraocular motility in all fields of gaze (Fig 1). The remainder of the neuro-ophthalmic...