A 62-year-old woman had 6 months of proximal weakness, fatigue and occasional diplopia, symptoms normally suggesting myasthenia gravis or inflammatory myopathy. Postexercise reflex facilitation is a bedside clinical sign that points to a diagnosis of the rarer alternative, Lambert-Eaton myasthenic syndrome (LEMS). We confirmed this diagnosis using electrodiagnostic short exercise testing and serum assay for voltage-gated calcium channel antibodies. Further investigation identified a small cell neuroendocrine carcinoma of the gallbladder, not previously associated with LEMS. Postexercise reflex facilitation is an important bedside clinical finding that helps clinicians to distinguish LEMS from its mimics.
- LAMBERT EATON SYNDROME
- PARANEOPLASTIC SYNDROME
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All data relevant to the study are included in the article or uploaded as supplementary information.
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Contributors MP, writing and conceptualisation of the manuscript.YCM, writing of the manuscript. PCY, writing of the manuscript. YHH, writing of the manuscript. GJN, writing of the manuscript. KP, writing of the manuscript. UT, writing and conceptualisation of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed by Jon Walters, Swansea, UK.
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