Myasthenia Gravis Associated With SARS-CoV-2 Infection

Restivo, Domenico A.; Centonze, Diego; Alesina, Alessandro; Marchese‐Ragona, Rosario

doi:10.7326/l20-0845

Cited by 150 publications

(158 citation statements)

References 5 publications

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“…Increasing evidence suggests that an enhanced immune response is involved in the physiopathology of a wide range of complications of SARS-CoV-2 infection, including neurological disorders [5]. Guillain-Barré syndrome, Miller Fisher syndrome, acute necrotizing encephalitis, myelitis, acute disseminated encephalomyelitis (ADEM), and myasthenia gravis have been reported after COVID-19 [6][7][8][9][10][11][12]. As in the described patient, immunotherapy seemed to have a beneficial effect in several of these cases.…”

supporting

confidence: 58%

Bickerstaff encephalitis after COVID-19

et al. 2020

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A 72-year-old woman with a history of hypertension, hyperlipidemia, smoking, and depression presented on early April 2020 with delirium and fever. A cranial CT scan was normal. A chest X-ray showed bilateral interstitial pneumonia, and nasopharyngeal exudate polymerase chain reaction (PCR) testing was positive to SARS-CoV-2. Cerebrospinal fluid (CSF) was normal. She was admitted and started on hydroxychloroquine, azithromycin, ceftriaxone, and IV methylprednisolone. A few days later she was transferred to the intensive care unit due to a cardiogenic shock caused by a myocardial infarction. Further hemodynamic and respiratory evolution was good, and she was discharged without delirium or cognitive impairment on day 22 after admission. She was readmitted eight days later due to a 48-h history of dizziness, oscillopsia, and unsteadiness. Her vital signs were normal, and she was afebrile. Systemic examination was unremarkable. She was conscious, and her language and speech were normal, but slight inattention and disorientation were present. A downbeat nystagmus in all gaze positions and impairment of smooth pursuit eye movements were present. Horizontal and vertical eye movements showed no limitation. Motor and sensory examinations were normal, and deep tendon reflexes were all present and symmetrical. The left plantar response was extensor. There was no limb dysmetria, but severe truncal ataxia was present. Reflex

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confidence: 58%

Bickerstaff encephalitis after COVID-19

et al. 2020

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“…There have been various case reports of COVID-19 infections in patients with pre-existing MG that have been published [7,9]. To the best of our knowledge, currently there is only one reported case series of MG developing as a complication following COVID-19 infection [15]. However, the three patients described in this case series were that of generalized MG.…”

Section: Discussionmentioning

confidence: 80%

New onset of ocular myasthenia gravis in a patient with COVID-19: a novel case report and literature review

et al. 2020

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The novel coronavirus outbreak of SARS-CoV-2 first began in Wuhan, China, in December 2019. The most striking manifestation of SARS-CoV-2 is atypical pneumonia and respiratory complications; however, various neurological manifestations are now well recognized. Currently, there have been very few case reports regarding COVID-19 in patients with a known history of myasthenia gravis. Myasthenia gravis (MG) causes muscle weakness, especially respiratory muscles, in high-risk COVID-19 patients, which can lead to severe respiratory compromise. There are few reported cases of severe myasthenia crisis following COVID-19, likely due to the involvement of the respiratory apparatus and the use of immunosuppressive medication. We report the first case of ocular MG developing secondary to COVID-19 infection in a 65-year-old woman. Two weeks prior to hospitalization, the patient suffered from cough, fever, and diarrhea and was found to be positive for COVID-19 via a nasopharyngeal RT-PCR swab test. The electrodiagnostic test showed decremental response over more than 10% on repetitive nerve stimulation test of orbicularis oculi. She tested positive for antibodies against acetylcholine receptor. COVID-19 is known to cause the release of inflammatory cytokines, leading to immune-mediated damage. MG is an immune-mediated disorder caused by molecular mimicry and autoantibodies against the neuromuscular junction.

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“…Finally, to date, only 3 possible cases of myasthenia gravis debut just after COVID-19 have been described (11).…”

Section: Nmd Manifestations Of Covid-19 Patientsmentioning

confidence: 99%

Neuromuscular Diseases Care in the Era of COVID-19

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2020

Front. Neurol.

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The COVID-19 pandemic has pushed health systems to their limit and forced readjustment of standards of care for different pathologies. Management of neuromuscular diseases becomes a challenge since most of them are chronic, disabling, progressive, and/or require immunosuppressive drugs. There are three main aspects of COVID-19 that affect neuromuscular diseases care. The first one relates to how SARS-CoV2 directly affects different neuromuscular pathologies. Respiratory weakness, as seen in myasthenia gravis, amyotrophic lateral sclerosis, and myopathies, and the use of immunomodulatory drugs (Myasthenia Gravis and Chronic Inflammatory Demyelinating Polyneuropathy) make this group of patients potentially more vulnerable. Secondly, safety measures also affect proper care, limiting care continuity, and physical rehabilitation (one of the essential aspects of myopathies treatment). Telemedicine can partially solve the problem allowing for a continuum of close care, avoiding unnecessary visits, and even guaranteeing the attention of professionals from tertiary care centers. However, one of the crucial steps in neuromuscular diseases is diagnosis, and in most scenarios, more than one face-to-face visit is needed. Lastly, the global COVID-19 situation will also have an economic impact on patients and their families. This situation is of particular concern given that neuromuscular diseases already present difficulties due to the scarcity of resources in terms of public healthcare and research.

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Myasthenia Gravis Associated With SARS-CoV-2 Infection

Cited by 150 publications

References 5 publications

Bickerstaff encephalitis after COVID-19

Bickerstaff encephalitis after COVID-19

New onset of ocular myasthenia gravis in a patient with COVID-19: a novel case report and literature review

Neuromuscular Diseases Care in the Era of COVID-19

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