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Four families each with two patients with autoimmune myasthenia gravis or related conditions are reported. All clinical forms of myasthenia gravis were represented and different disease types were found within the same family. Either one or two generations could be affected and no association with a single HLA haplotype was found. The frequency of familial autoimmune myasthenia gravis is very low and the genetic factors involved seem to be different from MHC genes.