Post-COVID-19 acquired myasthenia gravis: A review of reported cases

Abstract

Introduction: The emergence of cases of myasthenia gravis (MG) following SARS-CoV-2 infection suggests a potential triggering role of COVID-19 in the onset of this autoimmune disorder.

Objective: This literature review aims to synthesize the available evidence on the clinical, paraclinical, therapeutic, and outcome features of post-COVID MG to better characterize this emerging nosological entity.

Literature Review: Reported cases of MG occurring after COVID-19 describe both localized and generalized forms, typically appearing within weeks after infection. Autoimmune testing frequently reveals antibodies against acetylcholine receptors (anti-AChR), suggesting a virus-triggered or virus-amplified autoimmune mechanism. Patients present with variable degrees of muscle fatigability, ptosis, diplopia, or generalized weakness, independent of the initial severity of COVID-19. Management follows standard MG treatment protocols, including cholinesterase inhibitors, immunotherapy, and, in selected cases, thymectomy, with generally favorable outcomes when diagnosis is timely and treatment is appropriate.

Conclusion: Post-COVID myasthenia appears to be an emerging clinical entity, potentially distinct in its demographic, immunological, and outcome characteristics. Early recognition of this syndrome is crucial for initiating appropriate therapy, particularly in patients experiencing persistent fatigue after SARS-CoV-2 infection. More studies are needed to elucidate underlying mechanisms and optimize management strategies.

Keywords: Myasthenia gravis, COVID-19, Post-COVID fatigue, Autoimmunity, Anti-AChR antibodies.