Efficacy and safety of low-dose tacrolimus (3–5 mg/day) in steroid-resistant adult myasthenia gravis (MG) patients have been demonstrated in double-blind studies [1,2]. Tacrolimus promotes muscle strength recovery with lower doses of steroids in adults [1]. However, reports on tacrolimus use in children are scarce [3,4]. Although childhood-onset MG has better steroid reactivity and improved prognosis compared with adult-onset cases [5], some refractory pediatric MG cases are nonresponsive to steroids [6,7].

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