Myasthenia gravis associated with novel coronavirus 2019 infection: A report of three cases

An 82-year-old man presented with intermittent episodes of slurred speech during his evening meals after receiving the BNT162b2 COVID-19 vaccine. Thorough evaluation was conducted including lab work and EMG confirming a new diagnosis of late-onset myasthenia gravis. Despite treatment, the patient progressed rapidly to severe exacerbation requiring intubation and placement of a PEG tube. Infections provoking new diagnosis and exacerbations of myasthenia gravis have been reported. New diagnosis of myasthenia gravis associated with the COVID-19 vaccine is rarely reported. This case highlights the need for clinicians to be aware of the uncommon presenting symptoms in late-onset myasthenia gravis and the possibility of vaccine provoked diagnoses of immune mediated diseases.

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“… 3 , 4 New onset myasthenia gravis associated with SARS CoV 2 infection has also been described. 5 - 7 …”

Section: Discussionmentioning

confidence: 99%

“…3,4 New onset myasthenia gravis associated with SARS CoV 2 infection has also been described. [5][6][7] In contrast to associations with infections, onset or flares of autoimmune disorders associated with vaccines are rare. 8 We found 1 case of myasthenia gravis exacerbation associated with vaccination with the mRNA-1273 COVID-19 vaccine.…”

Section: Discussionmentioning

confidence: 99%

A Case of COVID-19 Vaccine Associated New Diagnosis Myasthenia Gravis

Chavez

Pougnier

2021

J Prim Care Community Health

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“…Myasthenia gravis is caused by the production of antibodies against nicotinic receptors in the neuromuscular junction, which reduces the number of functioning receptors by competitive blockade, increased receptor degeneration, or complement-mediated lysis of receptors [ 4 , 5 ]. In most of the patients, after the tests the presence of these antibodies was found [ 6 , 7 , 8 , 9 , 10 ] and one patient developed another type, anti-MusK, which blocks the formation of acetylcholine complexes in the synapses. In a study by Frida Essajee et al, experts from Stellenbosch University [ 8 ] described the recurrence of ocular myasthenia gravis caused by SARS-CoV-2 infection, resulting from the presence of ACE 2 receptors (angiotensin-converting enzyme 2), which are necessary for virus binding by cells.…”

Section: Literature Analysismentioning

confidence: 99%

“…There is a need for further research in this area. It is also not precisely known how and whether SARS-CoV-2 may trigger myasthenia gravis in subjects who did not suffer from it before [ 6 , 7 , 8 , 11 , 12 ]. It also noted the increasing occurrence of COVID-19 related multi-system inflammatory syndrome (MIS-C) among children in Africa.…”

Section: Literature Analysismentioning

confidence: 99%

Disorders of the Cholinergic System in COVID-19 Era—A Review of the Latest Research

Kopańska

Batoryna²,

Bartman

et al. 2022

IJMS

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The appearance of the SARS-CoV-2 virus initiated many studies on the effects of the virus on the human body. So far, its negative influence on the functioning of many morphological and physiological units, including the nervous system, has been demonstrated. Consequently, research has been conducted on the changes that SARS-CoV-2 may cause in the cholinergic system. The aim of this study is to review the latest research from the years 2020/2021 regarding disorders in the cholinergic system caused by the SARS-CoV-2 virus. As a result of the research, it was found that the presence of the COVID-19 virus disrupts the activity of the cholinergic system, for example, causing the development of myasthenia gravis or a change in acetylcholine activity. The SARS-CoV-2 spike protein has a sequence similar to neurotoxins, capable of binding nicotinic acetylcholine receptors (nAChR). This may be proof that SARS-CoV-2 can bind nAChR. Nicotine and caffeine have similar structures to antiviral drugs, capable of binding angiotensin-converting enzyme 2 (ACE 2) epitopes that are recognized by SARS-CoV-2, with the potential to inhibit the formation of the ACE 2/SARS-CoV-2 complex. The blocking is enhanced when nicotine and caffeine are used together with antiviral drugs. This is proof that nAChR agonists can be used along with antiviral drugs in COVID-19 therapy. As a result, it is possible to develop COVID-19 therapies that use these compounds to reduce cytokine production. Another promising therapy is non-invasive stimulation of the vagus nerve, which soothes the body’s cytokine storm. Research on the influence of COVID-19 on the cholinergic system is an area that should continue to be developed as there is a need for further research. It can be firmly stated that COVID-19 causes a dysregulation of the cholinergic system, which leads to a need for further research, because there are many promising therapies that will prevent the SARS-CoV-2 virus from binding to the nicotinic receptor. There is a need for further research, both in vitro and in vivo. It should be noted that in the functioning of the cholinergic system and its connection with the activity of the COVID-19 virus, there might be many promising dependencies and solutions.

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“…Patients with a neuromuscular junction disorder have a slightly increased mortality following SARS-CoV-2 infection, which is associated with comorbidities such as diabetes mellitus. 30 Onset of myasthenia gravis (MG) after infection 31 and vaccination against SARS-CoV-2 has also been reported. 32 The IRR for MG is higher in the 28 days following The data are in favor of vaccination of individuals with MG.…”

Section: Myasthenia Gravismentioning

confidence: 99%

Neuro-Ophthalmic Implications of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Related Infection and Vaccination

Petzold

2022

Asia-Pacific Journal of Ophthalmology

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic created a unique opportunity to study the effects of infection and vaccination on disease. The year 2020 was dominated by infection and its consequences. The year 2021 was dominated by vaccination and its consequences. It will still take several years for full maturation of databases required for robust epidemiological studies. Therefore, this review on the implications for neuro-ophthalmology draws on resources presently available including reported adverse reactions to vaccination. Illustrative clinical cases are presented. The spectrum of pathology following infection with SARS-CoV-2 falls into 4 main categories: autoimmune, vascular, sequelae of brain damage, and miscellaneous. This review is exhaustive, but the most common conditions discussed relate to headaches and associated symptoms; vertigo, diplopia, and nystagmus; vascular complications of the eye and brain; cranial nerve (mono-)neuropathies; photophobia, ocular discomfort, and optic neuritis. Of the 36 main adverse reactions reviewed, vaccine-induced immune thrombotic thrombocytopenia is a novel complication requiring specific hematological management. Updated diagnostic criteria are summarized. It is relevant to remember taking a medication history because of side effects and to recognize the relevance of comorbidities. The clinical assessment can frequently be performed virtually. Consensus recommendations on telemedicine and the virtual assessment are summarized in a practical and compressed format. The review concludes with an epidemiological tetralogy to interrogate, in future studies, associations with (1) SARS-CoV-2 pandemic infection, (2) SARS-CoV-2 worldwide vaccination, and (3) the possibility of a rebound effect of infections in the pandemic aftermath.

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Myasthenia gravis associated with novel coronavirus 2019 infection: A report of three cases

Cited by 25 publications

References 12 publications

A Case of COVID-19 Vaccine Associated New Diagnosis Myasthenia Gravis

A Case of COVID-19 Vaccine Associated New Diagnosis Myasthenia Gravis

Disorders of the Cholinergic System in COVID-19 Era—A Review of the Latest Research

Neuro-Ophthalmic Implications of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Related Infection and Vaccination

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