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Case Report
New onset of Myasthenia Gravis in a patient with COVID-19: A novel case report and literature review
Shitiz Sriwastava
West Virginia University
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6844-3286
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This work is licensed under a CC BY 4.0 License. Read Full License
Declarations:
Declarations
- This study involved human subjects.
- The author confirmed that all appropriate ethical guidelines for the use of human subjects have been followed, any necessary IRB and/or ethics committee review has been obtained, and information about the IRB/ethics committee is included in the manuscript.
- The author has confirmed that all necessary patient/participant consent or assent has been obtained and the appropriate institutional forms have been archived. If the IRB/ethics committee waived the requirement for patient/participant consent or assent, an explanation for the waiver is included in the text.
- This study is a case report.
- The author has confirmed that consent for publication of clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient or waiver of such consent is described in the text.
- The author has confirmed that a statement listing potential conflicts of interest or lack thereof is included in the text.
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.
Keywords
SARS-CoV-2, COVID-19, Myasthenia Gravis, Ocular Myasthenia, Neuromuscular disorder
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Case Report
New onset of Myasthenia Gravis in a patient with COVID-19: A novel case report and literature review
Shitiz Sriwastava
West Virginia University
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6844-3286
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 17 Sep, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Neurology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Declarations:
Declarations
- This study involved human subjects.
- The author confirmed that all appropriate ethical guidelines for the use of human subjects have been followed, any necessary IRB and/or ethics committee review has been obtained, and information about the IRB/ethics committee is included in the manuscript.
- The author has confirmed that all necessary patient/participant consent or assent has been obtained and the appropriate institutional forms have been archived. If the IRB/ethics committee waived the requirement for patient/participant consent or assent, an explanation for the waiver is included in the text.
- This study is a case report.
- The author has confirmed that consent for publication of clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient or waiver of such consent is described in the text.
- The author has confirmed that a statement listing potential conflicts of interest or lack thereof is included in the text.
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