01717nam a2200325   4500001000800000005001700008007000300025008004100028040000800069041000800077100003800085245009000123300002300213520065900236650001800895650003300913650002300946650003400969650002601003650003101029650001701060650002201077700003301099700003301132700003001165700003901195773010901234942003101343999001701374ESSALUD20260821145452.0ta      t        pe ||||| |||| 00| 0 spa d  aBMG  aeng  aAnkomah, Pierre O. eAutor954277  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.  aALERGIA97055  aINMUNOLOGÍA GENERAL953664  aENCEFALITIS913464  aOTORRINOLARINGOLOGÍA953837  aOFTALMOLOGÍA932364  aINFECCIONES VIRALES953766  aNEUROLOGÍA  aMENINGITIS911171  aCzawlytko, Cynthia L.954278  aEl Khoury, Joseph B. 954279  aAndrianus, Stefen 954280  aDonnelly-Morell, M. Lauren 9542810 022717922650dMassachusetts NEJM GroupoNEJM12tThe New England Journal of Medicine wESSALUDx0028-4793  cARTICULOSe2026-08-21zsqb  c22857d22857