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Temporal association between SARS-CoV-2 and new-onset myasthenia gravis: is it causal or coincidental?
  1. Y Muralidhar Reddy,
  2. Santhosh Kumar B,
  3. Syed Osman and
  4. Jagarlapudi M K Murthy
  1. Neurology, Care Hospital Banjara Hills, Hyderabad, India
  1. Correspondence to Dr Y Muralidhar Reddy; muralidharnims{at}gmail.com

Abstract

Several case reports of COVID-19 in patients with myasthenia gravis (MG) have been documented. However, new-onset autoimmune MG following COVID-19 has been reported very rarely. We report one such case here. A 65-year-old man presented to us with dysphagia 6 weeks following mild COVID-19. He was evaluated and diagnosed as antiacetylcholine receptor antibody (AchR) positive, non-thymomatous, generalised MG. He subsequently developed myasthenic crisis and improved after treatment with intravenous immunoglobulin, prednisolone and pyridostigmine. Systematic literature review showed eight more similar cases. Analysis of all cases including the one reported here showed these features: mean age 55.8 years, male gender (5), time interval between COVID-19 and MG (5–56 days), generalised (5), bulbar and/or ocular symptoms (4), anti-AchR antibodies (7) and antimuscle-specific kinase antibodies (2). All have improved with immunotherapy. Although, many hypothesis are proposed to explain causal relationship between the two, it could as well be sheer coincidence.

  • COVID-19
  • immunology
  • neurology
  • infectious diseases
  • neuromuscular disease

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Footnotes

  • Contributors YMR has conceptualised the study, compiled the data, conducted the literature search and written the manuscript; SKB and OS have assisted in the management of the case; JMKM has done final revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.