New onset of Myasthenia Gravis in a patient with COVID-19: A novel case report and literature review
The novel coronavirus outbreak of SARS-CoV-2 first began in Wuhan, China in December, 2019. The most striking manifestation is atypical pneumonia and respiratory complications, however various neurological manifestations are now well recognized. Currently, there have been a very few case reports in regards to COVID-19 in patients with known history of myasthenia gravis. Myasthenia gravis (MG) causes muscle weakness, especially respiratory muscles in high-risk COVID-19 patients that 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 from use of immunosuppressive medication.
We report a first case MG developing secondary to COVID-19 infection in a 65-year-old woman. Two weeks prior to hospitalization, the patient suffered from cough, fever, diarrhea and was found to be positive for COVID-19 via 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 (AchR).
COVID-19 is known to cause release of inflammatory cytokines leading to immune-mediated damage. MG is an immune-mediated disorder caused due to molecular mimicry and autoantibodies against the neuromuscular junction.
Figure 1
Posted 17 Sep, 2020
New onset of Myasthenia Gravis in a patient with COVID-19: A novel case report and literature review
Posted 17 Sep, 2020
The novel coronavirus outbreak of SARS-CoV-2 first began in Wuhan, China in December, 2019. The most striking manifestation is atypical pneumonia and respiratory complications, however various neurological manifestations are now well recognized. Currently, there have been a very few case reports in regards to COVID-19 in patients with known history of myasthenia gravis. Myasthenia gravis (MG) causes muscle weakness, especially respiratory muscles in high-risk COVID-19 patients that 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 from use of immunosuppressive medication.
We report a first case MG developing secondary to COVID-19 infection in a 65-year-old woman. Two weeks prior to hospitalization, the patient suffered from cough, fever, diarrhea and was found to be positive for COVID-19 via 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 (AchR).
COVID-19 is known to cause release of inflammatory cytokines leading to immune-mediated damage. MG is an immune-mediated disorder caused due to molecular mimicry and autoantibodies against the neuromuscular junction.
Figure 1