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Case Report
Shitiz Sriwastava
West Virginia University
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6844-3286
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that all necessary patient/participant consent or assent has been obtained and the appropriate institutional forms have been archived.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.
Keywords
SARS-CoV-2, COVID-19, Myasthenia Gravis, Ocular Myasthenia, Neuromuscular disorder
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Case Report
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
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