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Review
. 2021 Aug;268(8):2690-2696.
doi: 10.1007/s00415-020-10263-1. Epub 2020 Oct 12.

New onset of ocular myasthenia gravis in a patient with COVID-19: a novel case report and literature review

Shitiz Sriwastava  1 , Medha Tandon  2 , Saurabh Kataria  3 , Maha Daimee  4 , Shumaila Sultan  5
Affiliations
Review

New onset of ocular myasthenia gravis in a patient with COVID-19: a novel case report and literature review

Shitiz Sriwastava et al. J Neurol. 2021 Aug.

Abstract

The novel coronavirus outbreak of SARS-CoV-2 first began in Wuhan, China, in December 2019. The most striking manifestation of SARS-CoV-2 is atypical pneumonia and respiratory complications; however, various neurological manifestations are now well recognized. Currently, there have been very few case reports regarding COVID-19 in patients with a known history of myasthenia gravis. Myasthenia gravis (MG) causes muscle weakness, especially respiratory muscles, in high-risk COVID-19 patients, which can lead to severe respiratory compromise. There are few reported cases of severe myasthenia crisis following COVID-19, likely due to the involvement of the respiratory apparatus and the use of immunosuppressive medication. We report the first case of ocular MG developing secondary to COVID-19 infection in a 65-year-old woman. Two weeks prior to hospitalization, the patient suffered from cough, fever, and diarrhea and was found to be positive for COVID-19 via a nasopharyngeal RT-PCR swab test. The electrodiagnostic test showed decremental response over more than 10% on repetitive nerve stimulation test of orbicularis oculi. She tested positive for antibodies against acetylcholine receptor. COVID-19 is known to cause the release of inflammatory cytokines, leading to immune-mediated damage. MG is an immune-mediated disorder caused by molecular mimicry and autoantibodies against the neuromuscular junction.

Keywords: COVID-19; Myasthenia gravis; Neuromuscular disorder; Ocular myasthenia; SARS-CoV-2.

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Conflict of interest statement

All authors declare no potential conflicts of interest.

Figures

Fig. 1
Fig. 1
EMG repetitive nerve stimulation test of the left orbicularis oculi (facial nerve). The fourth run of the repetitive nerve stimulation of the left orbicularis oculi (facial nerve) demonstrated reproducible decrement of greater than 10% consistent with neuromuscular junction transmission defect. EMG electromyography test
See this image and copyright information in PMC

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