COVID-19 and generalized Myasthenia Gravis exacerbation: A case report

Singh, Shivangi; Govindarajan, Raghav

doi:10.1016/j.clineuro.2020.106045

Cited by 36 publications

(44 citation statements)

References 5 publications

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“…In our brief literature review, we reviewed 17 patients with known MG who were infected with COVID-19. All patients except one [ 10 ] were seropositive myasthenic patients on varying immunosuppressive therapies (majority on at least 2 agents, including pyridostigmine) and with varying disease status at the time of infection [ 7 – 9 , 11 – 13 , 16 ]. The patients were either continued on the same medication regimen during their COVID-19 infection or given an extra pulse dose of steroids or IVIG, depending on whether they were suffering from acute worsening of bulbar respiratory symptoms warranting further aggressive therapy.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…A few case reports have described COVID-19 infection in patients with pre-existing myasthenia gravis [2,[7][8][9][10][11][12][13]. However, to the best of our knowledge, there have been no reported cases of ocular myasthenia gravis being triggered by COVID-19 infection.…”

Section: Introductionmentioning

confidence: 99%

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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“…There are a few case reports of COVID-19 causing myasthenic crises; however, the outcomes and disease course seem to vary widely. 4,5 It is unclear which patient or disease feature can result in worse outcomes, and thus more study is needed. Current treatment guidelines for myasthenic crises include both intravenous immunoglobulin (IVIG) and plasma exchange as first-line options.…”

Section: Discussionmentioning

confidence: 99%

“…To date, there are two published reports of only six total patients that have been described in the current literature. 4,5 These isolated reports provide only limited guidance for the emergency physician on the recognition of COVID-19 in myasthenia gravis patients as they may present to the emergency department (ED), and none describe successful treatment using plasma exchange. This report highlights how isolated infection with COVID-19 with no signs on initial imaging studies can trigger a myasthenic crisis without any other clinical symptoms and how this patient was successfully treated with plasma exchange and steroid therapy alone.…”

Section: Introductionmentioning

confidence: 99%

Isolated COVID-19 Infection Precipitates Myasthenia Gravis Crisis: A Case Report

Moschella

Roth

2020

Clinical Practice and Cases in Emergency Medicine

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Introduction: Coronavirus disease 2019 (COVID-19) has spread around the world and caused hundreds of thousands of fatalities across a wide spectrum of patients with varying severity and presenting complaints. The discussion of the ability of this disease to cause significant illness in patients with various risk factors such as myasthenia gravis is important to help guide physicians on recognition and treatment options as the pandemic matures. Case Report: Here we discuss a single case of isolated COVID-19 infection that precipitated a myasthenic crisis with no other clinical sequelae in a patient who presented to the emergency department (ED). This report highlights some of the initial difficulties and delay in diagnosis encountered earlier in the pandemic with limited testing supplies and processing labs; however, prompt ED recognition and treatment still led to a favorable outcome. Conclusion: The patient recovered during this initial presentation and was successfully treated with plasma exchange and steroids only. It is important to recognize that myasthenia gravis patients may represent a uniquely vulnerable population that requires enhanced surveillance and screening to prevent significant morbidity and mortality. This case describes how even a mild infection with no significant clinical sequelae or significant signs on imaging studied can precipitate a crisis event.

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“…There are reports that described MG patients in whom the infection with SARS CoV-2 exacerbated MG ( Table 1) (16), but there are also reports that show that MG remained stable throughout an infection with SARS-CoV-2 ( Table 1) (3). According to a recent review about 16 MG patients experiencing a SARS-CoV-2 infection, MG deteriorated in eight patients and remained stable in the remaining patients (2).…”

Section: Does An Infection With Sars-cov-2 Worsen or Exacerbate Myastmentioning

confidence: 99%

Perspectives of Neuro-COVID: Myasthenia

Finsterer

Scorza

2021

Front. Neurol.

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COVID-19 and generalized Myasthenia Gravis exacerbation: A case report

Cited by 36 publications

References 5 publications

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

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

Isolated COVID-19 Infection Precipitates Myasthenia Gravis Crisis: A Case Report

Perspectives of Neuro-COVID: Myasthenia

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