01555nam a2200301   4500001000800000005001700008007000300025008004100028040000800069041000800077100003100085245009000116300002300206520065900229650001200888650002600900650001600926650002700942650001900969650002400988650001701012650001501029700002601044700002601070700002301096700003201119773010201151ESSALUD20260821145452.0ta      t        pe ||||| |||| 00| 0 spa d  aBMG  aeng  aAnkomah, Pierre O. eAutor  aCase 24-2026: A 74-year-old man with dyspnea, proximal muscle weakness, and hypoxemia  apáginas: 804-815  aThe patient had been in his usual state of health, with hypertension and dyslipidemia, until 7 months before the current presentation, when intermittent binocular diplopia developed. Evaluation by an ophthalmologist affiliated with this hospital revealed ptosis in the right eye and fluctuating strabismus that was not associated with a cranial nerve abnormality. Testing for acetylcholine receptor antibodies was positive, and computed tomography (CT) of the chest showed a normal thymus. Treatment with pyridostigmine was started for presumed ocular myasthenia gravis, and the patient was referred to the neurology clinic affiliated with this hospital.  aALERGIA  aINMUNOLOGÍA GENERAL  aENCEFALITIS  aOTORRINOLARINGOLOGÍA  aOFTALMOLOGÍA  aINFECCIONES VIRALES  aNEUROLOGÍA  aMENINGITIS  aCzawlytko, Cynthia L.  aEl Khoury, Joseph B.   aAndrianus, Stefen   aDonnelly-Morell, M. Lauren 0 022717dMassachusetts NEJM GroupoNEJM12tThe New England Journal of Medicine wESSALUDx0028-4793