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Review
. 2022 Dec 27;20(1):467.
doi: 10.3390/ijerph20010467.

COVID-19 Vaccination and Late-Onset Myasthenia Gravis: A New Case Report and Review of the Literature

Eleonora Virgilio  1   2 , Giacomo Tondo  2 , Claudia Montabone  2 , Cristoforo Comi  2
Affiliations
Review

COVID-19 Vaccination and Late-Onset Myasthenia Gravis: A New Case Report and Review of the Literature

Eleonora Virgilio et al. Int J Environ Res Public Health. .

Abstract

Myasthenia gravis (MG) is a rare autoimmune disease that is potentially threatening for patient life. Auto-antibodies targeting structures of the neuromuscular junction, particularly the acetylcholine receptor (AchR), are often found in the serum of MG patients. New-onset MG after SARS-CoV-2 vaccination has rarely been reported since the introduction of vaccination. Infections and COVID-19 infection have also been reported as possible triggers for a myasthenic crisis. We report a case of new-onset MG after receiving the mRNA COVID-19 vaccination. The patient was a 73-year-old male initially presenting with ocular symptoms and a rapid generalization. We also performed a literature revision of 26 described cases of MG after SARS-CoV-2 immunization. The patients were a majority of males with generalized late-onset MG occurring after the first dose of vaccine, similar to our patient. Only our patient showed a thymoma. Thymic mass and the positivity of AchR antibodies suggest that vaccination might have triggered a subclinical pre-existing MG with symptoms flaring. Clinicians should be aware of possible new-onset MG after COVID-19 vaccination, particularly in at-risk patients. Even though COVID-19 vaccination should be recommended in MG patients, particularly in well-compensated patients. However, more studies need to be performed in the future.

Keywords: Ach receptor; SARS-CoV-2; adverse drug events; autoimmune diseases; neuromuscular junction; vaccination hesitancy; vaccine.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the literature research.
Figure 2
Figure 2
Positron emission tomography (PET)-CT of our patient. Fused 18fluorodeoxyglucose [18F]FDG-PET and CT transverse, sagittal, and frontal images confirming a moderate [18F]FDG uptake in the anterior mediastinum (white arrows) with a maximum standardized uptake value (SUV) of 3.16, consistent with the suspicion of ectopic mass (most probably thymoma). The SUV is the ratio of the image-derived radioactivity concentration and the whole-body concentration of the injected radioactivity, and some authors have suggested that SUV is increasingly higher in thymic mass according to the WHO classification [19]. The histologic analysis confirmed the thymoma diagnosis.
Figure 3
Figure 3
(a) Distribution of patients according to the age at MG onset and diagnosis. (b) In the literature, the majority of MG new diagnoses after COVID-19 vaccination occurred in males with higher age (* p < 0.05) at onset and diagnosis (LOMG). (c) Distribution of patients according to the dose of vaccine and onset of MG. (d) Stratification of patients based on the dose of immunization and type of MG. Resampling methods were not conducted. Abbreviations: MG: myasthenia gravis, LOMG: late-onset MG.
Figure 3
Figure 3
(a) Distribution of patients according to the age at MG onset and diagnosis. (b) In the literature, the majority of MG new diagnoses after COVID-19 vaccination occurred in males with higher age (* p < 0.05) at onset and diagnosis (LOMG). (c) Distribution of patients according to the dose of vaccine and onset of MG. (d) Stratification of patients based on the dose of immunization and type of MG. Resampling methods were not conducted. Abbreviations: MG: myasthenia gravis, LOMG: late-onset MG.
See this image and copyright information in PMC

References

    1. Acter T., Uddin N., Das J., Akhter A., Choudhury T.R., Kim S. Evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as coronavirus disease 2019 (COVID-19) pandemic: A global health emergency. Sci. Total Environ. 2020;730:138996. doi: 10.1016/j.scitotenv.2020.138996. - DOI - PMC - PubMed
    1. Tondo G., Virgilio E., Naldi A., Bianchi A., Comi C. Safety of COVID-19 Vaccines: Spotlight on Neurological Complications. Life. 2022;12:1338. doi: 10.3390/life12091338. - DOI - PMC - PubMed
    1. Francis A.I., Ghany S., Gilkes T., Umakanthan S. Review of COVID-19 vaccine subtypes, efficacy and geographical distributions. Postgrad. Med. J. 2022;98:389–394. doi: 10.1136/postgradmedj-2021-140654. - DOI - PubMed
    1. Hasanzad M., Namazi H., Larijani B. COVID-19 anti-vaccine attitude and hesitancy. J. Diabetes Metab. Disord. 2022:1–4. doi: 10.1007/s40200-022-01018-y. - DOI - PMC - PubMed
    1. Causality Assessment of an Adverse Event Following Immunization (AEFI): User Manual for the Revised WHO Classification. [(accessed on 15 October 2022)]. Available online: https://www.who.int/publications-detail-redirect/9789241516990.