Myasthenia gravis with ocular symptoms following a ChAdOx1 nCoV-19 vaccination: A case report

Kang, Min; Park, Kyung-Ah; Min, Ju Hong; Oh, Sei Yeul

doi:10.1016/j.ajoc.2022.101620

Cited by 9 publications

(8 citation statements)

References 27 publications

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Section: Resultsmentioning

confidence: 88%

“…Another case report by Kang et al. ( 2022 ) also reported a 35‐year‐old male patient developing MG with ocular symptoms following the second dose of ChAdOx1 nCoV‐19 vaccination. Similarly, another case reported of ocular MG induced by the viral vector Oxford‐AstraZeneca coronavirus disease (COVID‐19) vaccine (Maher et al., 2022 ).Vaccines, particularly that with bovine, yeast, and chick antigens can induce subclinical autoimmunity as they synthesize antibodies that have the potential to cross‐react with AChR or MuSK protein, both causing myasthenia gravis (Arumugham, 2019 ).Infection, in this case with the SARS‐CoV‐2 virus, can then lead to a recall response of vaccine‐induced autoimmunity mediated by memory cells (Restivo et al., 2020 ).…”

Section: Resultsmentioning

confidence: 88%

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COVID‐19 and myasthenia gravis: A review of neurological implications of the SARS‐COV‐2

et al. 2022

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Introduction:This review highlights the potential mechanisms of neuromuscular manifestation of COVID-19, especially myasthenia gravis (MG).Methods: An extensive literature search was conducted by two independent investigators using PubMed/MEDLINE and Google Scholar from its inception to December 2020. Results: Exacerbations of clinical symptoms in patients of MG who were treated with some commonly used COVID-19 drugs has been reported, with updated recommendations of management of symptoms of neuromuscular disorders. Severe acute respiratory syndrome coronavirus 2 can induce the immune response to trigger autoimmune neurological disorders. Conclusions: Further clinical studies are warranted to indicate and rather confirm if MG in the setting of COVID-19 can pre-existent subclinically or develop as a new-onset disease.

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Section: Resultsmentioning

confidence: 88%

Section: Resultsmentioning

confidence: 88%

COVID‐19 and myasthenia gravis: A review of neurological implications of the SARS‐COV‐2

et al. 2022

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“…New onset or exacerbation of ocular or generalized MG has been reported after BioNTech/Pfizer mRNA-vaccine BNT162b2, Moderna mRNA-1273, and AstraZeneca ChAdOx1 vaccines. ( 85 , 86 ) The age and gender of those patients mostly followed the demographic of the second peak of MG disease, which is commonly seen in men who are above 60 years of age( 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 ). Exacerbation of pre-existing MG post-vaccine is thought to be from 1-15%.…”

Section: Discussionmentioning

confidence: 99%

“…( 87 ) Ocular MG cases presented with intermittent fatigable ptosis and diplopia. ( 88 , 90 , 92 , 94 ) In some of the cases, associated symptoms occurred such as fatigue and weakness, myalgia, dysarthria, dysphagia, and head drop. ( 87 , 89 , 91 , 93 ) In 8 of the 11 patients acetylcholine receptors (AchR) antibodies was positive, but none were positive for anti-muscle-specific kinase (MuSK) antibodies.…”

Section: Discussionmentioning

confidence: 99%

Neuro-Ophthalmic Complications of COVID-19 Infection and Vaccination

Alotaibi¹,

Badeeb²,

Karanjia³

2023

Advances in Ophthalmology and Optometry

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“…presents detailed information of the included 18 case studies(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) involving 48 patients. Twenty-eight of the 48 participants experienced the onset or flare of MG, and three of…”

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confidence: 99%

The safety of COVID-19 vaccines in patients with myasthenia gravis: A scoping review

et al. 2022

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BackgroundCOVID-19 vaccines are required for individuals with myasthenia gravis (MG), as these patients are more likely to experience severe pneumonia, myasthenia crises, and higher mortality rate. However, direct data on the safety of COVID-19 vaccines in patients with MG are lacking, which results in hesitation in vaccination. This scoping was conducted to collect and summarize the existing evidence on this issue.MethodsPubMed, Cochrane Library, and Web of Science were searched for studies using inclusion and exclusion criteria. Article titles, authors, study designs, demographics of patients, vaccination information, adverse events (AEs), significant findings, and conclusions of included studies were recorded and summarized.ResultsTwenty-nine studies conducted in 16 different countries in 2021 and 2022 were included. Study designs included case report, case series, cohort study, cross-sectional study, survey-based study, chart review, and systemic review. A total of 1347 patients were included. The vaccines used included BNT162b2, mRNA-1273, ChAdOx1 nCoV-19, inactivated vaccines, and recombinant subunit vaccines. Fifteen case studies included 48 patients reported that 23 experienced new-onset, and five patients experienced flare of symptoms. Eleven other types of studies included 1299 patients reported that nine patients experienced new-onset, and 60 participants experienced flare of symptoms. Common AEs included local pain, fatigue, asthenia, cephalalgia, fever, and myalgia. Most patients responded well to treatment without severe sequelae. Evidence gaps include limited strength of study designs, type and dose of vaccines varied, inconsistent window of risk and exacerbation criteria, limited number of participants, and lack of efficacy evaluation.ConclusionCOVID-19 vaccines may cause new-onset or worsening of MG in a small proportion of population. Large-scale, multicenter, prospective, and rigorous studies are required to verify their safety.

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Myasthenia gravis with ocular symptoms following a ChAdOx1 nCoV-19 vaccination: A case report

Cited by 9 publications

References 27 publications

COVID‐19 and myasthenia gravis: A review of neurological implications of the SARS‐COV‐2

COVID‐19 and myasthenia gravis: A review of neurological implications of the SARS‐COV‐2

Neuro-Ophthalmic Complications of COVID-19 Infection and Vaccination

The safety of COVID-19 vaccines in patients with myasthenia gravis: A scoping review

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