Temporal association between SARS-CoV-2 and new-onset myasthenia gravis: is it causal or coincidental?

Reddy, Y Muralidhar; B, Santhosh Kumar; Osman, Syed; Murthy, J. M. K.

doi:10.1136/bcr-2021-244146

Cited by 27 publications

(29 citation statements)

References 16 publications

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“… 3 , 4 New onset myasthenia gravis associated with SARS CoV 2 infection has also been described. 5 - 7 …”

Section: Discussionmentioning

confidence: 99%

“…The short time between vaccine administration and new diagnosis may also be explained by exacerbation of dormant or subclinical myasthenia gravis resulting in newly noticeable symptoms. 5 Subtle symptoms prior to vaccine administration may have been present but missed or ignored. Myasthenia gravis is underdiagnosed in those greater than 80 years old, with symptoms frequently misattributed to subjective fatigue and non-specific age-associated changes.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 New onset myasthenia gravis associated with SARS CoV 2 infection has also been described. [5][6][7] In contrast to associations with infections, onset or flares of autoimmune disorders associated with vaccines are rare. 8 We found 1 case of myasthenia gravis exacerbation associated with vaccination with the mRNA-1273 COVID-19 vaccine.…”

Section: Discussionmentioning

confidence: 99%

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A Case of COVID-19 Vaccine Associated New Diagnosis Myasthenia Gravis

Chavez

Pougnier

2021

J Prim Care Community Health

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An 82-year-old man presented with intermittent episodes of slurred speech during his evening meals after receiving the BNT162b2 COVID-19 vaccine. Thorough evaluation was conducted including lab work and EMG confirming a new diagnosis of late-onset myasthenia gravis. Despite treatment, the patient progressed rapidly to severe exacerbation requiring intubation and placement of a PEG tube. Infections provoking new diagnosis and exacerbations of myasthenia gravis have been reported. New diagnosis of myasthenia gravis associated with the COVID-19 vaccine is rarely reported. This case highlights the need for clinicians to be aware of the uncommon presenting symptoms in late-onset myasthenia gravis and the possibility of vaccine provoked diagnoses of immune mediated diseases.

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“… 3 , 4 New onset myasthenia gravis associated with SARS CoV 2 infection has also been described. 5 - 7 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Case of COVID-19 Vaccine Associated New Diagnosis Myasthenia Gravis

Chavez

Pougnier

2021

J Prim Care Community Health

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“…COVID-19 was declared as a pandemic by WHO on March 11th, 2020. To date, accumulating evidence has confirmed that SARS-CoV-2 is linked to MG. 10 case reports of new-onset MG following COVID-19 have been analyzed with the following features: mean age 51 years, male gender (6), time interval between COVID-19 and MG (5-56 days), generalized (7), bulbar and/or ocular symptoms (5), anti-AChR antibodies (9) and anti-muscle specific kinase antibodies (anti-MUSK) (2) (93,94).…”

Section: Covid-19 Vaccines In Mg Patients Sars-cov-2 Infection and Mgmentioning

confidence: 99%

To Be or Not To Be Vaccinated: That Is a Question in Myasthenia Gravis

Zhou

Yang

et al. 2021

Front. Immunol.

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Myasthenia gravis (MG) is an autoimmune disease characterized by muscle weakness and abnormal fatigability due to the antibodies against postsynaptic receptors. Despite the individual discrepancy, patients with MG share common muscle weakness, autoimmune dysfunction, and immunosuppressive treatment, which predispose them to infections that can trigger or exacerbate MG. Vaccination, as a mainstay of prophylaxis, is a major management strategy. However, the past years have seen growth in vaccine hesitancy, owing to safety and efficacy concerns. Ironically, vaccines, serving as an essential and effective means of defense, may induce similar immune cross-reactivity to what they are meant to prevent. Herein, we outline the progress in vaccination, review the current status, and postulate the clinical association among MG, vaccination, and immunosuppression. We also address safety and efficacy concerns of vaccination in MG, in relation to COVID-19. Since only a handful of studies have reported vaccination in individuals with MG, we further review the current clinical studies and guidelines in rheumatic diseases. Overall, our reviews offer a reference to guide future vaccine clinical decision-making and improve the management of MG patients.

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“…Variable conditions and neuropathies affecting the peripheral nervous system (PNS), including Guillain-Barrè syndrome and its variants ( 1 ), cranial multifocal neuropathy, dysautonomia ( 2 ), and brachial plexus lesion ( 3 ), have been described in subjects with COVID-19. Furthermore, neuromuscular disorders such as myalgia, myositis, and, in particular, myasthenia gravis (MG) have also been described ( 4 – 6 ). With regard to the association between MG and the COVID-19 infection, it has been observed that COVID-19 can exacerbate myasthenic crisis ( 7 ), promoting worsening of the clinical course and causing severe respiratory failure requiring intensive care unit (ICU) admission ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Case Report: Functional Outcome of COVID-19 Subjects With Myasthenia Gravis and Critical Illness Polyneuropathy

et al. 2022

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BackgroundThe COVID-19 disease can affect subjects suffering from myasthenia gravis (MG) and worsen its clinical course, leading to intensive care unit (ICU) admission. Critically ill subjects can develop a neuromuscular complication called ICU-acquired weakness (ICUAW). This disorder has also been detected in ICU subjects with COVID-19, but the association between MG and ICUAW has never been described in critically ill patients. We describe the case and functional outcome of a COVID-19 patient suffering from MG who developed critical illness polyneuropathy (CIP).Case PresentationA 66-year-old man with a history of hypertension and ocular MG had COVID-19 and required ICU admission. The patient underwent mechanical ventilation and tracheotomy and was treated with remdesivir and corticosteroids. Fifteen days after admission, he complained of tetraparesis without the ocular involvement that remained unchanged despite the increase in anticholinesterase therapy. The length of stay (LOS) in ICU was 35 days. On day 2 of admission, the patient underwent a frontal muscle jitter study that confirmed the MG, and electroneurography (ENG) and electromyography (EMG) that showed overlapping ICUAW with electrophysiological signs characteristic of CIP. The cerebrospinal fluid (CSF) showed normal pressure, cell count, and protein levels (<45 mg/dl) without albumin-cytologic disassociation. The CSF/serum glucose ratio was normal. The CSF culture for possible organisms, laboratory tests for autoimmune disorders, the panel of antiganglioside antibodies, and the paraneoplastic syndrome were negative. Strength and functional outcomes were tested with the MRC scale, the DRS, Barthel scale, and the Functional Independence Measure (FIM) at admission, discharge, and follow-up. Muscular strength improved progressively, and the MRC scale sum-score was 50 at discharge. Anticholinesterase therapy with pyridostigmine at a dosage of 30 mg 3 times daily, which the patient was taking before COVID-19, was resumed. His motor abilities recovered, and functional evaluations showed full recovery at follow-up.ConclusionIn the described subject, the coexistence of both neuromuscular disorders did not affect the clinical course and recovery, but the question remains about generalization to all patients with MG. The rehabilitation interventions might have facilitated the outcome.

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Temporal association between SARS-CoV-2 and new-onset myasthenia gravis: is it causal or coincidental?

Cited by 27 publications

References 16 publications

A Case of COVID-19 Vaccine Associated New Diagnosis Myasthenia Gravis

A Case of COVID-19 Vaccine Associated New Diagnosis Myasthenia Gravis

To Be or Not To Be Vaccinated: That Is a Question in Myasthenia Gravis

Case Report: Functional Outcome of COVID-19 Subjects With Myasthenia Gravis and Critical Illness Polyneuropathy

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