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The diagnosis of myasthenia gravis in a patient with typical oculopharyngeal weakness with diurnal variation of symptoms and fatigability is easy and can often be made on clinical grounds. Patients who present with pharyngeal and proximal limb weakness without a definite diurnal variation of symptoms are occasionally treated with empirical corticosteroids with a presumptive diagnosis of inflammatory myopathy. We report a case where the diagnosis of myasthenia gravis was delayed due to empiric therapy with steroids.
