A 3-Year-Old Boy Is Brought to the Office Due to Difficulty

A 3-year-old boy is brought to the office due to difficulty keeping up with the other children at day care.  Over the last 2 months, the day care attendants have noticed that the patient has seemed more tired and less interested in active play.  He has also had difficulty climbing stairs and jumping.  The patient's parents mention that he is still eating well and gaining weight but has had recurrent upper respiratory infections since starting day care.  His last upper respiratory infection began 5 days ago.  Temperature is 37 C (98.6 F) , blood pressure is 90/50 mm Hg, pulse is 94/min, and respirations are 18/min.  Examination shows clear rhinorrhea bilaterally.  Cardiopulmonary and abdominal examinations are normal.  Neurologic examination demonstrates 1+ patellar and Achilles reflexes bilaterally.  The calves are enlarged and nontender.  Which of the following is the most likely cause of this patient's presentation?

A) Absent dystrophin protein expression
B) Acetylcholine receptor antibody production
C) Muscle fiber viral inflammation
D) Neurotransmitter neurotoxin blockade
E) Peripheral nerve axon immune cross-reactivity

Correct Answer:

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