New onset of ocular myasthenia gravis in a patient with COVID-19: a novel case report and literature review.

Content Provider	Europe PMC
Author	Sriwastava, Shitiz Tandon, Medha Kataria, Saurabh Daimee, Maha Sultan, Shumaila
Abstract	The novel coronavirus outbreak of SARS-CoV-2 first began in Wuhan, China, in December 2019. The most striking manifestation of SARS-CoV-2 is atypical pneumonia and respiratory complications; however, various neurological manifestations are now well recognized. Currently, there have been very few case reports regarding COVID-19 in patients with a known history of myasthenia gravis. Myasthenia gravis (MG) causes muscle weakness, especially respiratory muscles, in high-risk COVID-19 patients, which can lead to severe respiratory compromise. There are few reported cases of severe myasthenia crisis following COVID-19, likely due to the involvement of the respiratory apparatus and the use of immunosuppressive medication. We report the first case of ocular MG developing secondary to COVID-19 infection in a 65-year-old woman. Two weeks prior to hospitalization, the patient suffered from cough, fever, and diarrhea and was found to be positive for COVID-19 via a nasopharyngeal RT-PCR swab test. The electrodiagnostic test showed decremental response over more than 10% on repetitive nerve stimulation test of orbicularis oculi. She tested positive for antibodies against acetylcholine receptor. COVID-19 is known to cause the release of inflammatory cytokines, leading to immune-mediated damage. MG is an immune-mediated disorder caused by molecular mimicry and autoantibodies against the neuromuscular junction.
ISSN	03405354
Journal	Journal of Neurology
Volume Number	268
PubMed Central reference number	PMC7549728
Issue Number	8
PubMed reference number	33047223
e-ISSN	14321459
DOI	10.1007/s00415-020-10263-1
Language	English
Publisher	Springer Berlin Heidelberg
Publisher Date	2020-10-12
Publisher Place	Berlin/Heidelberg
Access Restriction	Open
Rights License	This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Subject Keyword	SARS-CoV-2 COVID-19 Myasthenia gravis Ocular myasthenia Neuromuscular disorder
Content Type	Text
Resource Type	Article
Subject	Neurology Neurology (clinical)