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

Ramdas, Sithara; Hum, Ryan Malcolm; Price, Abigail; Annus, Paul; Bland, Jeremy D.P.; Burke, Georgine; Farrugia, Maria Elena; Palace, Jacqueline; Storrie, Alice; Ho, Pauline; Standing, Emma; Lilleker, James B; Jungbluth, Heinz

doi:10.1016/j.nmd.2022.09.001

Cited by 17 publications

(27 citation statements)

References 50 publications

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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%

“…Exacerbation of pre-existing MG post-vaccine is thought to be from 1-15%. ( 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.…”

Section: Discussionmentioning

confidence: 99%

“…( 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. ( 85 , 87 , 88 , 90 , 91 ) Electromyography was positive in 5 cases, showing either single-fiber electromyography (SFEMG) test of the orbicularis oculi identified with abnormal jitter or repetitive nerve stimulation providing diagnostic confirmatory for a postsynaptic neuromuscular junction disorder.…”

Section: Discussionmentioning

confidence: 99%

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Neuro-Ophthalmic Complications of COVID-19 Infection and Vaccination

Alotaibi¹,

Badeeb²,

Karanjia³

2023

Advances in Ophthalmology and Optometry

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Neuro-Ophthalmic Complications of COVID-19 Infection and Vaccination

Alotaibi¹,

Badeeb²,

Karanjia³

2023

Advances in Ophthalmology and Optometry

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“…The presentation and prognosis of COVID-19 in patients with pre-existing MG have been published since the onset of the COVID-19 pandemic [13][14][15][16][17][18]. Both new-onset MG post-SARS-CoV-2 infection [10,11,19,20] and post-vaccination are sparsely reported, and the pathophysiology is currently unclear [21]. The first case of post-COVID-19 new-onset MG with ocular manifestations in a 21-year-old female was reported by Huber et al in 2020 [11].…”

Section: Discussionmentioning

confidence: 99%

A Case Report and Literature Review of New-Onset Myasthenia Gravis After COVID-19 Infection

Chatterjee¹,

Kumaran²,

Roy³

2022

Cureus

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Myasthenia gravis (MG) is an autoimmune disorder affecting the neuromuscular junction caused by a B-cellmediated, T-cell-dependent immunologic attack at the end plate of the postsynaptic membrane. Attack on muscle acetylcholine receptors (AChR) of the postsynaptic membrane due to the AChR, muscle-specific tyrosine kinase, or lipoprotein receptor-related peptide 4 antibodies lead to symptoms of painless, fluctuating weakness of muscle groups and often begins with ocular signs and symptoms. Coronavirus disease 2019 (COVID-19) is an acute respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus closely related to SARS-CoV. Serious neurologic complications are infrequent and diverse with reported cases of stroke, encephalitis/meningitis, Guillain-Barré syndrome, acute disseminated encephalomyelitis, ataxia, and unspecified limb weakness. MG is a rarely reported sequela of COVID-19 infection. To date, there are 15 reported cases of post-COVID-19 MG. In this article, we present a case of post-COVID-19 MG and a concise review of other reported cases. An 83year-old Caucasian male with a medical history of atrial fibrillation status post-ablation and non-ischemic cardiomyopathy was initially admitted for COVID-19 pneumonia. He was treated with remdesivir, convalescent plasma, and supplemental oxygen therapy but did not require invasive mechanical intubation. One month after discharge, he started experiencing fatigue with muscle weakness and progressive dyspnea. He progressed to develop dysphonia, especially at the end of the day. After extensive workup, he was diagnosed with MG with a positive antibody against the AChR. The chronological events of developing slowly worsening muscular weakness after recovering from COVID-19 infection and positive AChR antibody led to the diagnosis of post-COVID-19 new-onset MG. Post-COVID-19 fatigue, long-term use of steroids, and intensive care unit-related physical deconditioning can be confounders in the clinical presentation of post-COVID-19 new-onset MG. Careful history-taking and meticulous assessment of chronological events are needed to diagnose this rare entity.

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

Cited by 17 publications

References 50 publications

Neuro-Ophthalmic Complications of COVID-19 Infection and Vaccination

Neuro-Ophthalmic Complications of COVID-19 Infection and Vaccination

A Case Report and Literature Review of New-Onset Myasthenia Gravis After COVID-19 Infection

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

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