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Atrophic extraocular muscles are rarely observed1–3 and bilateral extraocular muscle (EOM) atrophy is extremely rare.3 It has been reported in chronic progressive external ophthalmoplegia (CPEO) related to mitochondrial myopathies,4 myotonic dystrophy type 15 and in three other cases of myasthenia gravis (MG).4 This report is an atypical presentation of ocular MG with positive muscle-specific kinase (MuSK) antibodies and bilateral EOM atrophy.
A 49-year-old man presented with a 12-year history of slowly isolated progressive external ophthalmoplegia. His medical history was unremarkable and he did not take any drugs, smoke or drink alcohol. Examination revealed limitation of gaze in all directions to 3°–5° with bilateral …