Neuromuscular complications of HIV are related to immunodeficiency, direct cytotoxicity of the virus or side effect of the treatments. Autoimmune disorders involving the nervous system, including Guillain–Barre syndrome, myositis and vasculitis, have been described in association with HIV. Neuromuscular junction autoimmune diseases such as myasthenia gravis have been occasionally reported in patients with HIV, whereas the Lambert–Eaton myasthenic syndrome (LEMS) has never been described. We report an unusual case of paucisymptomatic LEMS in a patient with HIV infection.

Case report

A 42-year-old non-smoker, HIV positive, black African male was referred to us with a 2 year history of progressive but fluctuant weakness of the lower limbs. Comorbidities included chronic inactive hepatitis B with undetectable viraemia and a history of L4–5 laminectomy for a spinal canal stenosis. Treatment with highly active antiretroviral therapy (HAART) was initiated 6 months before hospitalisation, although neither biological nor clinical signs of immunosuppression were detected.

At the time of admission, he did not complain of diplopia, speech or swallowing, but had a dry mouth as the only autonomic symptom. Examination of the cranial nerves revealed a bilateral ptosis that was not modified by Simpson’s test (ie, ptosis worsened by effort). Examination of the upper limbs was normal except for symmetrical weak …