COVID-19 Vaccination and Late-Onset Myasthenia Gravis: A New Case Report and Review of the Literature

Myasthenia gravis (MG) is a rare autoimmune disease that is potentially threatening for patient life. Auto-antibodies targeting structures of the neuromuscular junction, particularly the acetylcholine receptor (AchR), are often found in the serum of MG patients. New-onset MG after SARS-CoV-2 vaccina...

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Bibliographic Details
Published in:International journal of environmental research and public health 2022-12, Vol.20 (1), p.467
Main Authors: Virgilio, Eleonora, Tondo, Giacomo, Montabone, Claudia, Comi, Cristoforo
Format: Article
Language:English
Subjects:
Acetylcholine receptors
Aged
Antibodies
Autoantibodies
Autoimmune diseases
Case Report
Case reports
Causality
Coronaviruses
COVID-19
COVID-19 - prevention & control
COVID-19 vaccines
COVID-19 Vaccines - adverse effects
Diabetes
Disease
Humans
Immunization
Infections
Literature reviews
Male
Males
mRNA
Myasthenia gravis
Myasthenia Gravis - diagnosis
Neuromuscular junctions
Pandemics
Patients
Receptors, Cholinergic
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Signs and symptoms
Thymoma
Thymus
Vaccination
Vaccines
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Description
Summary:Myasthenia gravis (MG) is a rare autoimmune disease that is potentially threatening for patient life. Auto-antibodies targeting structures of the neuromuscular junction, particularly the acetylcholine receptor (AchR), are often found in the serum of MG patients. New-onset MG after SARS-CoV-2 vaccination has rarely been reported since the introduction of vaccination. Infections and COVID-19 infection have also been reported as possible triggers for a myasthenic crisis. We report a case of new-onset MG after receiving the mRNA COVID-19 vaccination. The patient was a 73-year-old male initially presenting with ocular symptoms and a rapid generalization. We also performed a literature revision of 26 described cases of MG after SARS-CoV-2 immunization. The patients were a majority of males with generalized late-onset MG occurring after the first dose of vaccine, similar to our patient. Only our patient showed a thymoma. Thymic mass and the positivity of AchR antibodies suggest that vaccination might have triggered a subclinical pre-existing MG with symptoms flaring. Clinicians should be aware of possible new-onset MG after COVID-19 vaccination, particularly in at-risk patients. Even though COVID-19 vaccination should be recommended in MG patients, particularly in well-compensated patients. However, more studies need to be performed in the future.
ISSN:1660-4601
1661-7827
1660-4601
DOI:10.3390/ijerph20010467