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Spontaneously resolving late-onset ocular myasthenia related to COVID-19. A case report
1Victor Pauchet Clinic, Neurology, Amiens, France.
Abstract:
Myasthenia gravis (MG) is the most common disease of the neuromuscular junction disorders with bimodal distribution of age, which is often under-estimated in the elderly. Some clinical cases show an association between MG and COVID-19, since molecular mimicry between SARS-CoV-2 and AChR proteins could be responsible for the onset of the disease. We report a 77-year-old woman who developed right eyelid ptosis five days after COVID-19 infection. Positive serum anti-acetylcholine receptor antibodies allowed the diagnosis of myasthenia gravis. It should be noted that there were no significant decremental changes on 3 Hz repetitive motor nerve stimulation study, even for the affected orbicularis oculi muscle. Clinical and pathophysiological data suggest that inflammation during COVID-19 could trigger an overproduction of autoantibodies previously present in the body at a subclinical level. This is the first case of COVID-19 infection complicated by myasthenia gravis, to the best of our knowledge, that resolves spontaneously.
Insights
This case study details a 77-year-old woman who developed myasthenia gravis (MG) after COVID-19. Her symptoms resolved spontaneously, suggesting a potential link between viral infection and autoimmune response.
Area of Science:
- Neurology
- Immunology
- Infectious Diseases
Background:
- Myasthenia gravis (MG) is a neuromuscular junction disorder often underdiagnosed in the elderly.
- Emerging evidence suggests a potential link between COVID-19 and MG onset, possibly due to molecular mimicry between SARS-CoV-2 and acetylcholine receptor (AChR) proteins.
Observation:
- A 77-year-old woman presented with right eyelid ptosis 5 days post-COVID-19 infection.
- Diagnosis of myasthenia gravis was confirmed by positive serum anti-acetylcholine receptor antibodies.
- Repetitive motor nerve stimulation showed no significant decremental response, even in the affected muscle.
Findings:
- COVID-19 infection may trigger the overproduction of pre-existing subclinical autoantibodies.
- This case presents the first reported instance of myasthenia gravis following COVID-19 that resolved spontaneously.
Implications:
- The findings suggest that viral infections like COVID-19 can precipitate autoimmune responses in susceptible individuals.
- This highlights the importance of considering MG in elderly patients presenting with neurological symptoms post-COVID-19.
- Further research is warranted to understand the mechanisms linking viral infections and autoimmune neuromuscular disorders.
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