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Myasthenia gravis associated with anti-MuSK antibodies developed after SARS-CoV-2 infection.
Assini, Andrea; Gandoglia, Ilaria; Damato, Valentina; Rikani, Klaudio; Evoli, Amelia; Del Sette, Massimo.
  • Assini A; Neurology Unit, Galliera Hospital, Genoa, Italy.
  • Gandoglia I; Neurology Unit, Galliera Hospital, Genoa, Italy.
  • Damato V; Institute of Neurology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
  • Rikani K; Catholic University of the Sacred Heart, Rome, Italy.
  • Evoli A; Neurology Unit, Galliera Hospital, Genoa, Italy.
  • Del Sette M; Institute of Neurology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
Eur J Neurol ; 28(10): 3537-3539, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1015539
ABSTRACT

INTRODUCTION:

Since the onset of the novel coronavirus pandemic, several neurological complications secondary to SARS-CoV-2 infection have been reported, affecting central nervous system, peripheral nervous system and neuromuscular junction. CASE REPORT We present the case of a 77-year-old man who developed bulbar myasthenia gravis (MG) eight weeks after SARS-CoV-2 infection. The search for serum antibodies against the acetylcholine receptor and the muscle-specific tyrosine kinase (MuSK), performed by radioimmunoassay (RIA), and the search of low-density lipoprotein receptor-related protein 4 antibodies, performed by immunohistochemistry, resulted negative, while anti-MuSK antibodies were detected by cell-based assay (CBA). The patient was treated with pyridostigmine (60 mg four times a day) with unsatisfactory clinical response, followed by immunosuppressive therapy (azathioprine 1.5 mg/kg/day) with improvement of MG symptoms after two months of treatment.

DISCUSSION:

Several viral diseases have been described as associated with the onset of MG, although the underlying mechanisms are not yet fully understood. Similarly, a growing number of scientific reports suggest a correlation between SARS-CoV-2 infection and autoimmune diseases. The interest of our case lies in the timing of the MG onset (after 2 months from infection), together with the unusual late onset of anti-MuSK MG. These elements suggest that coronavirus infection may act as a trigger of the disease. We confirm the importance of CBA in the serological diagnosis of RIA-negative MG.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Myasthenia Gravis Type of study: Case report / Prognostic study Topics: Long Covid Limits: Aged / Humans / Male Language: English Journal: Eur J Neurol Journal subject: Neurology Year: 2021 Document Type: Article Affiliation country: Ene.14721

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Myasthenia Gravis Type of study: Case report / Prognostic study Topics: Long Covid Limits: Aged / Humans / Male Language: English Journal: Eur J Neurol Journal subject: Neurology Year: 2021 Document Type: Article Affiliation country: Ene.14721