Hepatocellular carcinoma presenting as paraneoplastic myasthenia gravis

Myasthenia (Myasthenia gravis MG) is an auto-immune disease of the neuromuscular junction. Autoantibodies (IgG) link to acetylcholine receptors, making them non-functional by internalisation and deterioration processes, and blocking the acetylcholine linkage. There is a well known correlation between MG and thymoma [1]. MG is less frequently associated with extrathymic malignancies [2]. During a paraneoplastic syndrome, it is hypothesized that autoantibody production is associated with an immune response against tumor cells. Paraneoplastic myasthenia gravis related to hepatocellular carcinoma (HCC) is very rare.