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A five-month-old male infant was brought into the emergency department by parents with hypotonicity (reduced muscular tone) and drowsiness that began the evening before. The infant presented with refractory atopic dermatitis and recent weight loss.

A 25 years-old, teacher, complains of double vision. She finds it difficult to talk after prolonged speaking. She is pregnant.Episodes of double vision began 6 weeks ago. Elsa’s husband reported fluctuating droopy eyelids in the morning and evening, which started 4 weeks ago.