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Iranian researchers reported the first case of myasthenia gravis (MG) following a vaccination of Sinopharm SARS-CoV-2, the virus that causes COVID-19.
The report follows evidence of an imaginable link between COVID-19 vaccination and MG. Although the mechanisms remain unclear, “if muscle weakness, eye and bulbar [neck and face] symptoms occur, MG deserves to be considered, even if it turns out to be a rare event,” the study team wrote.
The study, “A New Case of Myasthenia Gravis After COVID-19 Vaccination,” published in Neuroimmunology Reports.
MG is a rare autoimmune disease through autoreactive antibodies that attack neuromuscular junctions, sites of communication between nerve and muscle cells, causing fatigue and muscle weakness.
SARS-CoV-2 infection has been linked to the occurrence of MG in some studies. In addition, vaccination has been cited as a cause of the worsening of the disease. However, few reports have evaluated the protection and efficacy of COVID-19 vaccines in PATIENTS WITH MG.
Iranian researchers have described the case of a 68-year-old man who was admitted to a neurology clinic with difficulty swallowing and speaking.
Her symptoms progressed 3 days after receiving the timing dose of the Sinopharm COVID-19 vaccine (also known as BBIBP-CorV) and worsened within a month. At the time of his admission to the hospital, “he was in very poor health and helpless and may not even drink fluids,” the researchers wrote.
Produced in China, the vaccine is an inactive form of the SARS-CoV-2 virus that is no longer capable of causing disease but can still cause an immune response.
The patient, free of infection before and after vaccination, had no history of medication and considered himself “in his best physical condition before [receiving] the vaccine. “
He reported no headache, dizziness, blurred and double vision, and no focal weakness or numbness of limbs. Due to the inability to swallow, he drooled and had nasal speech. His family circle had no history of autoimmune diseases.
A neurological examination revealed partial drooping of the eyelids (ptosis) of both eyes. His pupils reacted to the softness, and his eyes moved normally. He had no facial asymmetry or numbness. Muscle tests and tendon reflexes were normal.
He was admitted to the hospital for further examinations. A brain MRI revealed no abnormalities. Blood tests were general and negative for SARS-CoV-2.
Doctors suspected a possible neuromuscular junction disorder and ordered further tests. He tested positive for antibodies to the acetylcholine receptor (AChR), the most common type of antibody that causes MG.
He underwent slow, repetitive nerve stimulation (RNS) in two facial muscles, and the effects are consistent with a diagnosis of MG. In RNS, electrodes are placed on the muscles that doctors need to test. Electrical impulses will have to be conducted through the nerves to elicit a muscular response. If the transmission of signs worsens with fatigue, which tends to occur after several cycles of stimulation, the patient will most likely have MG.
CT scans and MRIs tested negative for a tumor of the thymus gland, commonly known as thymoma, which accompanies MG.
The patient was treated with pyridostigmine (sold under the name Mestinon, among other logos), which is commonly prescribed to improve muscle strength in MG, as well as oral prednisolone, a corticosteroid. He also received intravenous immunoglobulins (IVIG). His condition improved particularly after treatment.
“Our case is the first of myasthenia gravis after a Sinopharm vaccine related to a higher titer of antibodies opposed to the acetylcholine receptor,” the researchers wrote, adding that if vaccination in MG patients outweighs the potential risks, “patients deserve to be aware of the imaginable exacerbation or brief worsening of symptoms after vaccination.
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