tetano
Editor, Senior Moderator
Eur J Neurol
. 2021 Jan 9.
doi: 10.1111/ene.14721. Online ahead of print.
Myasthenia gravis associated with anti-MuSK antibodies developed after SARS-CoV-2 infection
Andrea Assini[SUP] 1 [/SUP], Ilaria Gandoglia[SUP] 1 [/SUP], Valentina Damato[SUP] 2 3 [/SUP], Klaudio Rikani[SUP] 1 [/SUP], Amelia Evoli[SUP] 2 3 [/SUP], Massimo Del Sette[SUP] 1 [/SUP]
Affiliations
Abstract
Introduction: Since the onset of the novel coronavirus pandemic, several neurological complications secondary to SARS-CoV-2 infection have been reported, affecting central nervous system, peripheral nervous system and neuromuscular junction.
Case report: We present the case of a 77-year-old man who developed bulbar myasthenia gravis (MG) eight weeks after SARS-CoV-2 infection. The search for serum antibodies against the acetylcholine receptor, the muscle-specific tyrosine kinase (MuSK), and the low-density lipoprotein receptor-related protein 4 antibodies, performed by radioimmunoassay (RIA), resulted negative, while anti-MuSK antibodies were detected by cell-based assay (CBA). The patient was treated with pyridostigmine (60 mg four times a day) with unsatisfactory clinical response, followed by immunosuppressive therapy (azathioprine 1.5 mg/kg/day) with improvement of MG symptoms after two months of treatment.
Discussion: Several viral diseases have been described as associated with the onset of MG, although the underlying mechanisms are not yet fully understood. Similarly, a growing number of scientific reports suggest a correlation between SARS-CoV-2 infection and autoimmune diseases. The interest of our case lies in the timing of the MG onset (after two months from infection), together with the unusual late onset of anti-MuSK MG. These elements suggest that coronavirus infection may act as a trigger of the disease. We confirm the importance of CBA in the serological diagnosis of RIA-negative MG.
Keywords: Myasthenia Gravis; SARS-CoV-2; anti-MuSK antibodies; cell-based assay.
. 2021 Jan 9.
doi: 10.1111/ene.14721. Online ahead of print.
Myasthenia gravis associated with anti-MuSK antibodies developed after SARS-CoV-2 infection
Andrea Assini[SUP] 1 [/SUP], Ilaria Gandoglia[SUP] 1 [/SUP], Valentina Damato[SUP] 2 3 [/SUP], Klaudio Rikani[SUP] 1 [/SUP], Amelia Evoli[SUP] 2 3 [/SUP], Massimo Del Sette[SUP] 1 [/SUP]
Affiliations
- PMID: 33421278
- DOI: 10.1111/ene.14721
Abstract
Introduction: Since the onset of the novel coronavirus pandemic, several neurological complications secondary to SARS-CoV-2 infection have been reported, affecting central nervous system, peripheral nervous system and neuromuscular junction.
Case report: We present the case of a 77-year-old man who developed bulbar myasthenia gravis (MG) eight weeks after SARS-CoV-2 infection. The search for serum antibodies against the acetylcholine receptor, the muscle-specific tyrosine kinase (MuSK), and the low-density lipoprotein receptor-related protein 4 antibodies, performed by radioimmunoassay (RIA), resulted negative, while anti-MuSK antibodies were detected by cell-based assay (CBA). The patient was treated with pyridostigmine (60 mg four times a day) with unsatisfactory clinical response, followed by immunosuppressive therapy (azathioprine 1.5 mg/kg/day) with improvement of MG symptoms after two months of treatment.
Discussion: Several viral diseases have been described as associated with the onset of MG, although the underlying mechanisms are not yet fully understood. Similarly, a growing number of scientific reports suggest a correlation between SARS-CoV-2 infection and autoimmune diseases. The interest of our case lies in the timing of the MG onset (after two months from infection), together with the unusual late onset of anti-MuSK MG. These elements suggest that coronavirus infection may act as a trigger of the disease. We confirm the importance of CBA in the serological diagnosis of RIA-negative MG.
Keywords: Myasthenia Gravis; SARS-CoV-2; anti-MuSK antibodies; cell-based assay.