New Onset of Myasthenia Gravis following COVID-19 Vaccination: A Case Report

Abstract

Myasthenia gravis (MG) is a rare autoimmune disease and the most common neuromuscular junction disorder. The most common symptoms are diplopia, ptosis, and fluctuating weakness of ocular and limb muscles. Here we report a case of MG after COVID-19 vaccination. A 37-year-old Iranian lady presented with generalized weakness, diplopia, and ptosis after three days from taking the second dose of COVID-19 vaccine. Symptoms began three days after taking the second dose of Sinopharm BIBP COVID-19 vaccine (BBIBP-CorV) and worsened within a week. Her past medical history included migraine-type headaches and gastric reflux. She was consuming Rizatriptan and Nortriptyline for her migraine headache and Pantoprazole, Domperidone, and Sertraline for stomach reflux. She had a family history of Essential tremor in her father, uncle, and grandfather. Antibody against the acetylcholine receptor (AChR-Ab) was more than eight times compared to the normal range. The pattern of repetitive nerve stimulation was suggestive for MG. Treatment with corticosteroid, azathioprine, and pyridostigmin led to amelioration of symptoms. Follow-up testing revealed AChR-Ab returned to the normal range. There are some case reports in that a chronic autoimmune disorder flared up after the COVID1-9 infection or its vaccination. There are several reports of MG exacerbations, acute respiratory distress syndrome, higher ICU admission, and mortality rate and worsening neurological symptoms after COVID-19 infection. There is still debate about the association between neuromuscular disorders and COVID-19 infection and vaccination. This matter is more doubtful for myasthenia gravis.