Laryngeal myasthenia gravis following influenza vaccination: a case report and literature review

Vaccines and myasthenia gravis: a comprehensive review and retrospective study of SARS-CoV-2 vaccination in a large cohort of myasthenic patients

“…The risk was higher for ILI than for influenza vaccination Influenza Ellen Strijbos et al 2019 [ 23 ] 47 anti-AchR AChR + MG pts: 29 with (IM +) and 18 without (IM-) immunosuppressive therapy; 47 healthy controls Longitudinal prospective, placebo-controlled study 4 weeks No clinical exacerbations nor significant change in AchR-antibodies titres after 4 weeks and between IM + and IM- after influenza vaccination Influenza Björn Tackenberg et al 2018 [ 24 ] 62 MG pts: 31 vaccine vs 31 placebo Longitudinal prospective, placebo-controlled trial 12 weeks No significant difference in AchR-antibodies titres. Adverse events, exacerbations and therapeutical modifications were comparable between groups Influenza Wang et al 2021 [ 25 ] 1 non-myasthenic subject Case report 6 months Onset of laryngeal MG 5 days after trivalent inactivated influenza vaccine. Significant attenuation of symptoms after 2 weeks of pyridostigmine and steroids HBV Domingo et al 2009 [ 26 ] 1 asthmatic non-myasthenic subject and 1 MG patient Case series (not specified) The non-myasthenic subject developed generalised anti-AchR + MG 1 week after HBV vaccine, while the MG patient had an exacerbation in the month following HBV vaccination HBV Biron et al 1988 [ 28 ] 1 asthmatic non-myasthenic subject Case report (not specified) Onset of generalised MG after general anaesthesia and HBV vaccine, treated with immunosuppressive drugs and plasma-exchange HBV Louzir et al 2003 [ 29 ] 1 asthmatic non-myasthenic subject Case report (not specified) Onset of MG after HBV vaccine; MG exacerbation, requiring ventilator care and IVIg, 4 years later HBV …”

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 ].…”

“…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] .…”

Is Myasthenia Gravis a Real Complication of the COVID-19 Vaccine? A Case Report-Based Systematic Review

“…It has been hypothesized that an antibody that cross-reacts with autonomic ganglia, neurons, and cardiovascular proteins could be synthesized by the HPV vaccine epitope and that the production of the antibody could activate cytotoxic T cells by binding to acetylcholine receptors [ 36 , 37 ]. The other number of factors, including hepatitis B virus (HBV) [ 38 , 39 ], bacillus Calmette–Guerin (BCG) [ 40 ], and the influenza vaccines [ 41 ], led to MG.…”