Introduction: Myasthenia gravis (MG) is an antibody-mediated disorder of the neuromuscular junction characterized by fluctuating muscle weakness and fatiguability . Immune thrombocytopenic purpura (ITP) is an autoimmune condition causing thrombocytopenia and increased risk of bleeding. Co-occurrence of MG and ITP is rare, particularly in paediatric population. We report the case of a child with refractory ITP who subsequently developed MG and achieved remission following rituximab. Case Report: A 9-year-old girl was diagnosed with ITP and started on oral prednisolone. Three months later, she developed bilateral ptosis. Clinical examination demonstrated fatiguability; sustained upward gaze resulted in worsening ptosis. Anti-AChR and anti-MuSK antibodies was negative. CT scan showed thymic hyperplasia. She was diagnosed with seronegative Juvenile Ocular MG. Pyridostigmine was started with mild improvement in ocular symptoms. Subsequently , she developed proximal limb weakness and progressed to generalized MG. She received intravenous immunoglobulin (IVIG). Given ongoing refractory ITP and worsening MG, treatment was escalated to rituximab. Following rituximab, platelet counts normalized and myasthenic symptoms resolved. Pyridostigmine was discontinued. She has remained in clinical remission from both haematological and neuromuscular perspectives. Conclusion: MG may coexist with other autoimmune conditions, though association between MG and ITP in children is rare. First-line therapy for both MG and ITP commonly include corticosteroids. Rituximab has emerged as an effective treatment for refractory ITP and MG. In our patient, early use of rituximab resulted in remission of both autoimmune conditions. Further studies are needed to investigate co-existence of MG and ITP and whether earlier introduction of rituximab improves remission rates.