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Systemic lupus erythematosus (SLE) and myasthenia gravis (MG) are autoimmune diseases, whose association in the same patient is rarely reported. Both pathologies share the following characteristics: affect mainly young women; alternate exacerbation and remission periods; and have positive antinuclear antibody (ANA) test. This case report assesses possible diagnostic hypotheses for the clinical fi ndings of eyelid ptosis and proximal muscle weakness in a female patient recently diagnosed with SLE, who evolved with associated MG.

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The electrocardiographic records of 849 normal individuals between the age of 1 and 16 years were studied, and the arithmetic sum of the voltages SV2 and RV5 were calculated. Values considerably in excess of those usually quoted were found to exist in this age group, the mean being 38.0 mm ± 9.7 and the range 15 mm to 65 mm. A new set of means and standard deviations for this index have been prepared. Variations in these values are evident with advancing age, and these appear to be related to sex. Whereas there is no difference in voltages between the sexes in children under the age of 11 years, over this age the females present values which become progressively smaller with the advance of puberty (both in relation to their previous values and to the values found in males), reaching a mean level 17 mm lower than that of the males by the age of 16 years. The males show no significant difference in voltage after and before the age of 11 years, while the females do. The possible causes for these trends have been briefly discussed. As a result of this study and in contradistinction to adult experience it is considered unwise to rely on precordial voltage alone as an index of left ventricular hypertrophy unless the SV2 + RV5 value is greater than 60 mm in children less than 11 years of age, or greater than 55 mm in females and 65 mm in males past 11 years of age.