According to a story from Myasthenia Gravis News, a recent report describes the first-ever documented case of a patient developing the ocular variant of myasthenia gravis in connection with COVID-19 infection. The individual was a female of 65 years who had a history of comorbidities such as a clot affecting the pulmonary artery, pituitary tumor, and kidney cancer. Though the patient’s treatment was mostly successful, she still displayed residual symptoms of COVID and myasthenia gravis.
About Myasthenia Gravis
Myasthenia gravis is a long term autoimmune disease that is most characterized by weakness of the skeletal muscles which can affect a patient’s ability to move and breathe. Ocular myasthenia gravis is a term for disease where symptoms are limited to the eyes, though this often can progress to the generalized form. As an autoimmune disease, myasthenia gravis is ultimately the result of abnormal immune system behavior in which the system attacks normal body tissue. In this disease, the immune system produces antibodies that inhibit regular neuromuscular function. Symptoms of the illness include muscle weakness that worsens after activity and gets better after resting. This weakness may affect the face, eyes, neck, breathing, and limbs. It may cause speech and swallowing difficulties, eyelid drooping, shortness of breath, and blurred vision. In severe cases, patients may require breathing assistance with a ventilator. Treatment options for myasthenia gravis include immunosuppressive medications, thymus gland removal, IVIG, and plasmapharesis. Most patients can effectively manage the condition with treatment. To learn more about myasthenia gravis, click here.
About the Case
The patient was ultimately hospitalized after experiencing symptoms such as muscle pain, severe fatigue, diarrhea, and drooping affecting her left eye. She had experienced ocular symptoms for three days and had been dealing with the others for around two weeks. The patient did not have shortness of breath, which is common in more serious cases of COVID-19. She was found to have double vision upon evaluation.
Lab tests revealed elevated markers of inflammation in her bloodstream. The tests also revealed abnormally elevated anti-AChR antibodies. Electromyography confirmed that she had ocular myasthenia gravis. On day three of her stay, she began treatment with pyridostigmine (marketed as Mestinon), which is an approved therapy for the rare disease. As her symptoms began to subside, she was discharged.
Unfortuately, the patient was hospitalized again only a few days later as symptoms of diarrhea, nausea, and loss of smell and taste emerged. Septic shock caused her blood pressure to plummet and she was given oxygen supplementation. These symptoms were determined to be caused by COVID-19. She continued treatment with pyridostigmine and was also given dexamethasone. The patient spent another ten days in the hospital, but symptoms of myasthenia gravis and COVID-19 were still present a month later.
Myasthenia gravis has been found in other COVID-19 patients and scientists believe that the immune response to the infection could lead to secondary attacks on the neuromuscular junction. The researchers conclude that this case could represent either a complication of the infection or a case that emerged primarily post-infection. Ultimately, studying additional cases as they appear will be critical to understanding the broader picture.
Check out the full study here.
