Overlap of limited cutaneous systemic sclerosis with ocular myasthenia gravis- report of a case and a brief review of literature

A 39-year-old woman with a 4-year history of limited cutaneous systemic sclerosis (lcSSc) and no prior exposure to D-penicillamine presented with bilateral fluctuating ptosis of 1 week duration. On evaluation, she was found to have elevated acetylcholine receptor antibody levels and a positive neostigmine test confirming the diagnosis of ocular myasthenia gravis (MG). The patient was treated with oral prednisolone and pyridostigmine resulting in significant improvement within 2 weeks. The co-occurrence of systemic sclerosis (SSc) and MG is rare and when such an association is seen, it is usually seen in the background of D-Penicillamine therapy for SSc. The presence of fluctuating ptosis in SSc is a valuable clinical clue to suspect co-existence of neuromuscular junction disorder like MG.