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Progressive bilateral ophthalmoparesis—a case of simultaneous autoimmunity: balancing Graves’ ophthalmoparesis and ocular myasthenia
  1. Carlo Canepa1,
  2. Maya Venu2
  1. 1Department of Stroke and Neurology, James Paget University Hospital, Norwich, UK
  2. 2Emergency Admissions and Discharge Unit (EADU), James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK
  1. Correspondence to Dr Carlo Canepa, Neurocanepa{at}


A 44-year-old woman with no medical history presented with a 1-year history of horizontal diplopia, bilateral exophthalmos and progressive asymmetrical ophthalmoparesis, with no pupillary dysfunction or ptosis. Within 3 months of her initial presentation, she noticed paresis of right eye abduction, followed after 1 month with paresis of left eye abduction. Initial investigations revealed positive antiperoxidase antibodies for Graves’ disease and positive AChR for myasthenia gravis. MRI of the brain showed increased intensity in bilateral inferior rectus muscles and CT of the chest showed thymic hyperplasia. Treatment with carbimazole and pyridostigmine was started, with complete resolution after 1 month.

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