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Journal of Pediatric Neurology 2023; 21(06): 450-452
DOI: 10.1055/s-0043-1761932
Case Report

A Case of Generalized Myasthenia Gravis Exacerbated by COVID-19

Shingo Kanatani
1   Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
,
Hiroshi Yamaguchi
1   Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
,
Shizuka Oikawa
1   Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
,
Shoichi Tokumoto
1   Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
,
Kazumi Tomioka
1   Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
,
Masahiro Nishiyama
2   Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
,
Kandai Nozu
1   Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
,
Hiroaki Nagase
1   Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
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Abstract

Myasthenia gravis (MG) is a rare, long-term neuromuscular disorder that can affect individuals of any age. In Japan, the Omicron variant of coronavirus disease 2019 (COVID-19) began spreading in 2022, and many cases of neurological symptoms caused by the virus have been reported. Although COVID-19 has been reported to exacerbate MG in adults, there are no reports on the effects of COVID-19 on the MG symptoms of pediatric patients. We report the case of a 6-year-old girl with a 3-year history of MG who presented to our hospital with symptom exacerbation after COVID-19 infection. Four days before admission, she developed fever with a runny nose and cough. Three days before admission, she developed severe bilateral blepharoptosis and progressive limb weakness, and 2 days before admission, she was diagnosed with COVID-19 by SARS-CoV-2 antigen test. Physical examination revealed moderate blepharoptosis and mild bilateral upper and lower limb weakness. We diagnosed her with worsening MG due to COVID-19, and she was administered 400 mg/kg intravenous immunoglobulin (IVIG) daily for 5 days with continued oral corticosteroids and tacrolimus. The patient's symptoms improved promptly after admission and, at discharge 7 days after admission, her symptoms had significantly improved. During the 1-month outpatient follow-up period, she remained stable and the anti-acetylcholine receptor (AchR) antibody level was reduced to 14.6 nmol/L (from 18.5 nmol/L on admission). Our case suggests that COVID-19 exacerbates MG in both children and adults.

Keywords

anti-acetylcholine receptor - immunoglobulin - MG - SARS-CoV-2 - steroid

Informed Consent

Informed consent for publication was obtained from the patient's parents.




Publication History

Received: 22 November 2022

Accepted: 05 January 2023

Article published online:
10 February 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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