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Case Reports
. 2022 Oct;43(10):5799-5802.
doi: 10.1007/s10072-022-06284-5. Epub 2022 Jul 23.

New-onset myasthenia gravis after mRNA SARS-CoV-2 vaccination: a case series

Gaia Fanella  1   2 , Claudio Baiata  3   4 , Elisa Candeloro  3 , Gianpaolo Toscano  3 , Silvia Colnaghi  3 , Marco Mauri  3   5 , Lucia Princiotta Cariddi  3   6 , Valentina Rebecchi  3 , Francesca Solazzo  3 , Paola Banfi  3 , Marialuisa Piatti  7 , Carlo Ferrarese  4   7 , Maurizio Versino  3   5
Affiliations
Case Reports

New-onset myasthenia gravis after mRNA SARS-CoV-2 vaccination: a case series

Gaia Fanella et al. Neurol Sci. 2022 Oct.

Abstract

Background: Myasthenia gravis (MG) is an autoimmune disease that targets acetylcholine receptor (AChR) of the neuromuscular junction. New-onset MG after SARS-CoV-2 vaccination has rarely been reported.

Case presentation: We report about three patients who presented new-onset myasthenia gravis after receiving mRNA SARS-CoV-2 vaccination. The patients were all males and older than 55 years. All the patients presented with ocular and bulbar symptoms. The interval between vaccine administration and MG onset ranged from 3 days after the first dose to 10 days after the second dose. All the patients had elevated serum AChR antibodies and responded to pyridostigmine. Two out of three patients were successfully treated with IVIG or plasma exchange and with long-term immunosuppression.

Conclusions: MG is a rare disease; clinicians should be aware of possible new-onset MG after SARS-CoV-2 vaccination, especially with the current recommendation of booster doses. The hyperstimulation of the innate immune system or the exacerbation of a subclinical pre-existing MG could be possible explanations.

Keywords: COVID-19; Myasthenia gravis; SARS-CoV-2; Vaccine; mRNA.

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Conflict of interest statement

The authors declare no competing interests.

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