FRI0248 Myasthenia gravis after hepatitis b vaccine. report of one case

Abstract

Objectives In this study we compared the clinical findings and some provocative tests (Tinnel, Phalen, reverse phalen) with electrophysological examination (ENMG) results. Methods This study was carried out on 48 patients who had pain, numbness, tingling and weakness complaints in at least one hand. Provocative tests and ENMG investigation were applied for each patient whom suspected for carpal tunnel syndrome. 67 hands of 48 patients which represent positive sign for carpal tunnel syndrome were evaluated and compared with ENMG positivity. In order to evaluate validity of provacative tests, chisquare test was used. Positive-negative predictive values of provocative tests also investigated. Results 20 patients had bilateral complaints, 28 patients had complaints only in one hand. When compared with ENMG results, reverse Phalen test was founded most spesific test (% 78.8). This was followed by Tinnel test%72.3 and Phalen test% 70.2. Conclusion We concluded that provacative tests for ENMG have increased sensitivity, for that reason can be applied in epidemiological studies for carpal tunnel syndrome. But to make an definite diagnosis of carpal tunnel syndrome electrophysiological examination should be applied.

Early-Onset Myasthenia Gravis Following COVID-19 Vaccination

“…A few studies have reported new-onset MG after administration of vaccines against influenza, hepatitis B, and human papillomavirus. 8 9 10 11 These patients have exhibited ocular and/or bulbar symptoms. The time interval between vaccination and symptom onset has ranged from three days to six weeks.…”

SARS-CoV-2 vaccination and new-onset myasthenia gravis: A report of 7 cases and review of the literature

“…Vaccines have been previously implicated in MG exacerbation/new onset MG including influenza, hepatitis B, human papilloma virus and Bacillus Calmette‑Guerin [ 6 , [26] , [27] , [28] , [29] , [30] , [31] , [32] ] [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] but the likely mechanism in these cases remains unclear. Two double-blind randomised controlled trials which evaluated changes in AChR titre and symptom exacerbations in MG patients following influenza vaccination included 109 patients who were followed up between 4 and 12 weeks after influenza vaccination with no statistically significant changes in MG exacerbations and AChR titres noted [ 43 , 44 ].…”

“…A UK study noted an increased risk of hospitalisation and death from myasthenic disorders in a window of 15-21 days after the first dose of the Oxford-Astra Zeneca® vaccine but none following doses of the Pfizer-BioNTech® vaccine [42] . In our cohort of 14 cases (7 new and 7 previously published cases) with new onset MG following SARS-CoV-2 vaccination, the mean interval from receiving the SARS-CoV-2 vaccine to symptom onset was 4.5 days (IQR 2-7.75, range [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. This contrasts with a previously published report based on 30-years of data from the United States Vaccine Adverse Event Reporting System of new-onset MG or pre-existing MG exacerbation post vaccination which reported a higher mean time to symptom onset of 10 days [7] .…”

“…Several vaccines including influenza, hepatitis B, human papilloma virus (HPV), and Bacillus Calamette-Geurin have been implicated in new onset MG or exacerbation of already established MG [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] . Molecular mimicry has been postulated as a possible mechanism with HPV L1 but this does not necessarily explain the mechanisms associated with other vaccination-induced cases [13] .…”

“…There is accumulating evidence to suggest that SARS-CoV-2 virus can activate autoimmunity through a variety of mechanisms including hyperstimulation of the immune system, excess activation of neutrophil-associated cytokine response and neutrophil extracellular traps (NET) as well as molecular mimicry between host and virus, a mechanism that has been previously proposed for other viral antigens [4] . Several vaccines including influenza, hepatitis B, human papilloma virus (HPV), and e Bacillus Calmette-Guérin have been implicated in new onset MG or exacerbation of already established MG [5][6][7][8][9][10][11][12][13] . Molecular mimicry has been postulated as a possible mechanism with HPV L1 but this does not necessarily explain the mechanisms associated with other vaccination-induced cases [13] .…”