MuSK Antibody–Associated Myasthenia Gravis With SARS-CoV-2 Infection: A Case Report

Muhammed, Louwai; Baheerathan, Aravindhan; Cao, Michelangelo; Leite, Maria Isabel; Viegas, Stuart

doi:10.7326/l20-1298

Cited by 36 publications

(43 citation statements)

References 5 publications

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“…The HLA-B*08:01 is associated with myasthenia gravis ( 105 ), and the HLA-B*07:02 is associated with neurological ADs ( 85 ). Reports are available about myasthenia gravis associated with SARS-CoV-2 infection ( 68 , 106 – 108 ). Surface glycoprotein is the leading antigen of interest for vaccine development against SARS-CoV-2 ( 109 ).…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Proteome Harbors Peptides Which Are Able to Trigger Autoimmunity Responses: Implications for Infection, Vaccination, and Population Coverage

et al. 2021

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Autoimmune diseases (ADs) could occur due to infectious diseases and vaccination programs. Since millions of people are expected to be infected with SARS-CoV-2 and vaccinated against it, autoimmune consequences seem inevitable. Therefore, we have investigated the whole proteome of the SARS-CoV-2 for its ability to trigger ADs. In this regard, the entire proteome of the SARS-CoV-2 was chopped into more than 48000 peptides. The produced peptides were searched against the entire human proteome to find shared peptides with similar experimentally confirmed T-cell and B-cell epitopes. The obtained peptides were checked for their ability to bind to HLA molecules. The possible population coverage was calculated for the most potent peptides. The obtained results indicated that the SARS-CoV-2 and human proteomes share 23 peptides originated from ORF1ab polyprotein, nonstructural protein NS7a, Surface glycoprotein, and Envelope protein of SARS-CoV-2. Among these peptides, 21 peptides had experimentally confirmed equivalent epitopes. Amongst, only nine peptides were predicted to bind to HLAs with known global allele frequency data, and three peptides were able to bind to experimentally confirmed HLAs of equivalent epitopes. Given the HLAs which have already been reported to be associated with ADs, the ESGLKTIL, RYPANSIV, NVAITRAK, and RRARSVAS were determined to be the most harmful peptides of the SARS-CoV-2 proteome. It would be expected that the COVID-19 pandemic and the vaccination against this pathogen could significantly increase the ADs incidences, especially in populations harboring HLA-B*08:01, HLA-A*024:02, HLA-A*11:01 and HLA-B*27:05. The Southeast Asia, East Asia, and Oceania are at higher risk of AD development.

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Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Proteome Harbors Peptides Which Are Able to Trigger Autoimmunity Responses: Implications for Infection, Vaccination, and Population Coverage

et al. 2021

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“…So far nine cases with SARS-CoV-2 infection who subsequently develop MG have been described, all with typical features including ptosis and diplopia (see Table 1). six exhibited a generalized phenotype which predominantly involved bulbar muscles and three had restricted ocular symptoms 10,11,12,13,14,15,16 . Two individuals with a generalized subtype had antibodies against MuSK, the others being positive for anti AChR.…”

Section: Discussion Andmentioning

confidence: 99%

Dropped Head Syndrome in Myasthenia Gravis After a SARS‐CoV‐2 Infection: Case Report

Kreinter

Barroso

Botero

et al. 2022

Preprint

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Introduction: The current pandemic by the SARS-CoV-2 has affected the world's general population. While the predominant presentation is with respiratory disease, neurological complications are increasingly recognized. Post-infectious immune-mediated disorders such as Guillain Barré syndrome and Myasthenia Gravis (MG) have been described.Case presentation: We report a case with an unusual presentation of myasthenia gravis after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection . We also present a retrospective review of the literature of all the reported cases of de novo myasthenia gravis associated with SARS-CoV2 infection from march-2020 to april-2021. Conclusion: Myasthenia gravis could also be the result of an autoimmune reaction triggered by SARS-CoV-2 infection.

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“…To date, there were reports of eight such patients published in the literature. [5][6][7][8][9][10] Clinical features of all nine patients, including one described in this report, are summarised in table 1. The Majority were aged above 50 years (67%) and suffered mild COVID-19 (75%).…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] New-onset autoimmune MG has also been reported, although rarely following COVID-19. [5][6][7][8][9][10] We describe one such patient with new-onset autoimmune MG following COVID-19 and review the current literature.…”

Section: Introductionmentioning

confidence: 99%

Temporal association between SARS-CoV-2 and new-onset myasthenia gravis: is it causal or coincidental?

Reddy

Osman

et al. 2021

BMJ Case Rep

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Several case reports of COVID-19 in patients with myasthenia gravis (MG) have been documented. However, new-onset autoimmune MG following COVID-19 has been reported very rarely. We report one such case here. A 65-year-old man presented to us with dysphagia 6 weeks following mild COVID-19. He was evaluated and diagnosed as antiacetylcholine receptor antibody (AchR) positive, non-thymomatous, generalised MG. He subsequently developed myasthenic crisis and improved after treatment with intravenous immunoglobulin, prednisolone and pyridostigmine. Systematic literature review showed eight more similar cases. Analysis of all cases including the one reported here showed these features: mean age 55.8 years, male gender (5), time interval between COVID-19 and MG (5–56 days), generalised (5), bulbar and/or ocular symptoms (4), anti-AchR antibodies (7) and antimuscle-specific kinase antibodies (2). All have improved with immunotherapy. Although, many hypothesis are proposed to explain causal relationship between the two, it could as well be sheer coincidence.

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MuSK Antibody–Associated Myasthenia Gravis With SARS-CoV-2 Infection: A Case Report

Cited by 36 publications

References 5 publications

SARS-CoV-2 Proteome Harbors Peptides Which Are Able to Trigger Autoimmunity Responses: Implications for Infection, Vaccination, and Population Coverage

SARS-CoV-2 Proteome Harbors Peptides Which Are Able to Trigger Autoimmunity Responses: Implications for Infection, Vaccination, and Population Coverage

Dropped Head Syndrome in Myasthenia Gravis After a SARS‐CoV‐2 Infection: Case Report

Temporal association between SARS-CoV-2 and new-onset myasthenia gravis: is it causal or coincidental?

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