RT Journal Article SR Electronic T1 Coexistence of myasthenia gravis with hypokalemic periodic paralysis: a rare presentation JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e231241 DO 10.1136/bcr-2019-231241 VO 12 IS 10 A1 Farah Gul Khan A1 Sidra Namran YR 2019 UL http://casereports.bmj.com/content/12/10/e231241.abstract AB Bilateral symmetrical weakness of acute onset is not very uncommon and the differential varies widely from life-threatening neurological illnesses to metabolic and electrolyte derangements. We report the case of a young female with severe muscle weakness, respiratory distress and hypokalemia who required immediate intubation on arrival to emergency department. During hospital course, even after normalisation of serum potassium and some improvement in limb weakness, patient failed multiple attempts of extubation because of type II respiratory failure. Subsequently, acetyl cholinesterase antibodies were checked which came out positive, and diagnosis of myasthenia gravis and hypokalemic periodic paralysis was made. She was successfully extubated after intravenous pulse steroids, pyridostigmine and plasmapheresis. Patient was finally discharged home on oral steroids, pyridostigmine and azathioprine. In a patient presenting with hypokalemic weakness, the suspicion of a second disorder should be very high if weakness fails to resolve following correction of hypokalemia.