Recurrent pneumonia warrants a diligent work-up to identify
the underlying cause that perpetuates the disease process.
Insidious bulbar dysfunction is arguably the most
devastating as it would be diagnosed late after significant
pulmonary complications due to chronic micro-aspiration.
Bulbar disorder should be considered as the potential
aetiology of recurrent pulmonary infections in the young
population after excluding immunodeficiency disorder and
respiratory anatomical anomaly. This report illustrates a rare
case of bulbar onset myasthenia gravis which manifested as
focal bronchiolectasis due to recurrent undiagnosed
aspiration pneumonia three years earlier. Absence of
hallmark features of Myasthenia Gravis (MG) such as ptosis,
opthalmoplegia and proximal muscle weakness contributed
to the diagnostic delay and challenges in this case. The
diagnosis was established with the collaboration of
multidisciplinary teams. Subsequent correct therapeutic
interventions resulted in remarkable recovery in functional
status and prevented her from further aspiration in the long
run.