Respiratory dysfunction as first presentation of myasthenia gravis misdiagnosed as COVID-19

Background: The outbreak of the coronavirus disease 2019 (COVID-19) has had profound impact on health care not only for its direct effects, but also because it deeply influenced the whole clinical practice and diagnostic pathways, particularly in the acute setting. Case report: We present the case of a patient with respiratory dysfunction due to myasthenia gravis (MG) initially misdiagnosed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to ambiguity in the interpretation of radiological and microbiological findings during COVID-19 pandemic. Discussion: Respiratory dysfunction as first clinical manifestation of myasthenia gravis is rare, but potentially very harmful. Emergency physicians should always consider neurological diseases when dyspnea cannot be explained by cardiac or respiratory causes.