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Transient acetylcholine receptor-related myasthenia gravis, post multisystem inflammatory syndrome in children (MIS-C) temporally associated with COVID-19 infection
  1. Farida Essajee,
  2. Juanita Lishman,
  3. Regan Solomons,
  4. Deepthi Raju Abraham,
  5. Pierre Goussard and
  6. Ronald Van Toorn
  1. Pediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
  1. Correspondence to Professor Pierre Goussard; pgouss{at}


We report on a unique case of a 7-year-old girl with new onset ocular myasthenia gravis shortly after recovery from multisystem inflammatory syndrome in children (MIS-C) temporally associated with SARS-CoV-2 infection. The diagnosis of myasthenia gravis was based on suggestive symptoms of fatigable bilateral orbital ptosis, diplopia, positive ocular cold compression test and serum acetylcholine receptor antibody positivity, as well as a favourable treatment response to pyridostigmine. The addition of corticosteroids and methotrexate resulted in complete resolution of the ocular signs.

  • COVID-19
  • neurology (drugs and medicines)
  • paediatrics (drugs and medicines)
  • neuroimaging
  • neuromuscular disease

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  • Contributors Dr FE, Professor RS and Professor RVT were the neurologists insole with the case. Professor PG is the pulmonologist. Dr Abraham and Dr Lishman were the infectious disease and immunologist involved. All were involved in writing the manuscript.

  • 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.

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