Objective: To describe a case of a male patient presenting with anti-Musk positive Myasthenia Gravis (MG) and Parkinson’s Disease (PD) with an adequate response to levodopa.

Background: An 72-year-old patient began experiencing clinical symptoms of cervical weakness, dyspnea, and dysphagia 11 years prior, with symptoms worsening over 3 years. He was diagnosed with myasthenia gravis with anti-Musk positive antibodies and initiated treatment with pyridostigmine, azathioprine, and prednisone. Months later, assessments revealed asymmetric parkinsonism characterized by resting tremor in the right upper limb, bradykinesia, and rigidity in the right hemibody, with an adequate response to prolopa and a positive family history for Parkinson’s (mother and sister). 6 years after the onset of symptoms, the patient experienced a myasthenic crisis, requiring a change in myasthenia gravis treatment to cyclosporine, which he used for 2 years, necessitating a change due to a skin reaction. Currently, the patient uses levodopa 1000mg/day divided into 4 doses, in addition to mycophenolate 500 mg twice daily, prednisone 5mg daily, and pyridostigmine 60mg 4 times a day, with stability in both neurological conditions

Method: We conducted a literature review of Parkinson’s disease concomitant with Myasthenia Gravis

Results: MG is a neuromuscular disease that affects the neuromuscular junction, causing fluctuating muscle weakness. Anti-Musk positive antibodies represent 10% of all cases, and these cases are generally clinically more severe. The association of MG with PD is rare; however, there are currently 60 reported cases, which can pose a diagnostic difficulty and confound adequate patient treatment. A characteristic found in most cases is the late-onset presentation of MG, as well as a large proportion of described cases presenting bulbar symptoms and cervical weakness. Currently, there is no description of causality or direct association between these two diseases. However, we are seeing more and more descriptions of this type of case, indicating that it is not as rare as previously thought

Conclusion: The presentation of MG and PD is rare, which can be a diagnostic challenge. However, more and more cases with this dual diagnosis are being described

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