Juvenile autoimmune myasthenia gravis: diagnostic utility of diurnal ptosis and the ice pack test

Juvenile autoimmune myasthenia gravis (JAMG) is uncommon in children and extremely rare in infants. The condition is frequently recognised late since it mimics congenital and neuromuscular disorders. We report a case of a toddler presenting with fluctuating bilateral ptosis that worsened in the evening. The bedside ice pack test was positive, and serum acetylcholine receptor antibodies confirmed the diagnosis. A chest CT scan revealed no abnormalities in the thymus. The child showed a good response to anticholinesterase treatment. This case emphasises the significance of recognising fatigable ptosis and employing simple bedside assessments for the early diagnosis of juvenile autoimmune myasthenia gravis.