Isolated dysphagia is a rare form of presentation of myasthenia gravis (MG), resulting in discoordinated peristalsis. Accidental aspiration of barium sulfate may occur during radiological examinations of the upper gastrointestinal system using contrast media in conditions affecting the anatomical and functional integrity of the oropharynx and the esophagus. Though inert, barium may result in severe pulmonary inflammatory reaction and acute respiratory distress syndrome (ARDS). Thus, it is important to identify patients at risk of aspiration. Timely consideration of MG during evaluation of dysphagia is crucial to prevent complications and improve the quality of life. Whenever neuromuscular weakness is suspected, videofluroscopic technique for barium swallow needs to be advocated. We, hereby, report an unusual case of MG who presented with dysphagia only and developed fatal barium aspiration pneumonitis.
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