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The Clinical Course of New-Onset Ocular Myasthenia Gravis Caused by Pfizer-BioNTech COVID-19 Vaccine
1Department of Neurology, En Chu Kong Hospital, New Taipei City 237, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei 100, Taiwan.
Purpose:
Myasthenia gravis (MG) caused by COVID-19 vaccine had been reported, but the clinical course of new-onset ocular MG had never been described. We would like to document the clinical course of a patient with new-onset ocular MG which was caused by Pfizer-BioNTech COVID-19 vaccine.
Case Report:
A 39-year-old woman noticed diplopia one week after she accepted the first dose of Pfizer- BioNTech COVID-19 vaccine. Diagnosis of ocular MG was made after investigation. Despite intravenous immunoglobulins, pyridostigmine and prednisolone therapy, she had no improvement until 10 days after treatment. She then rapidly improved, and almost fully recovered in the following 10 days. We had observed this patient for 8 months. After tapering off steroid, she remained stable to date, though she still suffered from transient diplopia on awakening.
Conclusion:
No matter the symptoms at onset, the clinical course or the response to steroid therapy was identical to ocular MG that we had ever known. Ocular MG caused by COVID-19 vaccine could probably be an iatrogenic life-long disease.
Insights
New-onset ocular myasthenia gravis (MG) following the Pfizer-BioNTech COVID-19 vaccine presented with typical symptoms and responded to standard treatment. This case suggests COVID-19 vaccination may trigger a potentially lifelong autoimmune condition.
Area of Science:
- Neurology
- Immunology
- Vaccinology
Background:
- Myasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular junctions.
- While COVID-19 vaccines are generally safe and effective, rare adverse events have been reported.
- The specific clinical course of new-onset ocular MG following COVID-19 vaccination has not been previously documented.
Observation:
- A 39-year-old woman developed diplopia one week after her first Pfizer-BioNTech COVID-19 vaccine dose.
- Ocular MG was diagnosed, and the patient received intravenous immunoglobulins, pyridostigmine, and prednisolone.
- Initial treatment showed no improvement for 10 days, followed by rapid recovery within the subsequent 10 days.
Findings:
- The patient's clinical presentation, disease course, and response to steroid therapy were consistent with typical ocular MG.
- After an 8-month observation period, the patient remained stable after steroid tapering, with only occasional transient diplopia upon awakening.
Implications:
- COVID-19 vaccination may induce new-onset ocular myasthenia gravis.
- This iatrogenic condition appears to follow a similar clinical course and treatment response as non-vaccine-induced MG.
- Ocular MG triggered by COVID-19 vaccination could represent a potentially lifelong autoimmune condition requiring long-term management.
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