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Case Report

New Onset Generalized Myasthenia Gravis Evolving Following SARS-CoV-2 Infection

Department of Neurology, Tartu University Hospital, 50406 Tartu, Estonia
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Author to whom correspondence should be addressed.
Academic Editor: Francesco Caruso
COVID 2022, 2(4), 464-471; https://doi.org/10.3390/covid2040033
Received: 6 March 2022 / Revised: 19 March 2022 / Accepted: 23 March 2022 / Published: 30 March 2022
(This article belongs to the Special Issue Correlations between COVID-19 and the Immune System)
During the SARS-CoV-2 (COVID-19) pandemic, the immunogenicity of the virus for various autoimmune complications has been observed. To date, a few reports have been published that raise the possibility of new onset myasthenia gravis (MG) associated with COVID-19 infection. We report a case of a 65-year-old male who developed his initial myasthenic presentation with mild dysarthria 14 days after COVID-19 infection symptomatic onset. His bulbar symptoms, diplopia, and ptosis progressed considerably over the next 1.5 months before he was diagnosed with non-thymomatous MG. Serological tests showed a high concentration of anti-acetylcholine receptor and anti-titin antibodies. He responded well to treatment with pyridostigmine and intravenous immunoglobulin. Reasonable latency from COVID-19 infection and gradual evolvement of myasthenic symptoms makes the causative association probable in this case. To our knowledge, this is the first report of anti-titin antibodies in new-onset MG associated with COVID-19 infection. In the article, we analyze the previously reported cases and summarize the information published to date. We discuss the possible immunological mechanisms behind new onset autoimmune disease following a viral infection and the associated features that raise the suspicion for such a possibility. We also hint at structural homologies between SARS-CoV-2 spike glycoprotein and titin epitopes. View Full-Text
Keywords: myasthenia gravis; SARS-CoV-2; acetylcholine receptor; titin; antibodies; autoimmunity myasthenia gravis; SARS-CoV-2; acetylcholine receptor; titin; antibodies; autoimmunity
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MDPI and ACS Style

Jõgi, K.; Sabre, L.; Rosental, M.; Leheste, A.-R.; Vilisaar, J. New Onset Generalized Myasthenia Gravis Evolving Following SARS-CoV-2 Infection. COVID 2022, 2, 464-471. https://doi.org/10.3390/covid2040033

AMA Style

Jõgi K, Sabre L, Rosental M, Leheste A-R, Vilisaar J. New Onset Generalized Myasthenia Gravis Evolving Following SARS-CoV-2 Infection. COVID. 2022; 2(4):464-471. https://doi.org/10.3390/covid2040033

Chicago/Turabian Style

Jõgi, Karl, Liis Sabre, Merit Rosental, Alo-Rainer Leheste, and Janek Vilisaar. 2022. "New Onset Generalized Myasthenia Gravis Evolving Following SARS-CoV-2 Infection" COVID 2, no. 4: 464-471. https://doi.org/10.3390/covid2040033

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