Early Flare-Ups of Myasthenia Gravis After Thoracoscopic Thymectomy in a Patient Recently Receiving BNT162b2 mRNA COVID-19 Vaccination.

Permphan Dharmasaroja

doi:10.7759/cureus.21571

Abstract

Myasthenia gravis (MG) is an autoimmune disorder characterized by abnormal neuromuscular transmission. The thymus is believed to play a key role in the pathogenesis of MG, and thymectomy has been an optional treatment for the disease. Relapse of MG after thymectomy has been reported. Exacerbations and new onset of MG following COVID-19 vaccination have also been documented. This report presents a case of a stable MG patient with recent COVID-19 vaccination experiencing flare-ups of symptoms shortly after video-assisted thoracoscopic (VATS) thymectomy. A 31-year-old female received the second dose of the BNT162b2 mRNA COVID-19 vaccine eight days before thymectomy and developed flare-ups of symptoms four days after the surgery. Although the substantial link between MG exacerbations post-thymectomy and pre-thymectomy COVID-19 vaccination cannot be concluded, this observation warrants further research.

Highlights

Myasthenia gravis (MG) is an autoimmune neurologic disease characterized by abnormal neuromuscular transmission
This paper reports a temporal relationship between the BNT162b2 COVID-19 vaccination and symptom exacerbations shortly after thymectomy in a young female MG patient
Post-surgery myasthenia crisis has been reported, this condition is usually related to respiratory muscle paralysis due to prolonged or repeated mechanical ventilation. None of these factors, except generalized MG, was found in the patient in this report. It is uncertain whether thymectomy performed soon after COVID-19 vaccination contributed to MG aggravation

Summary

Introduction

Myasthenia gravis (MG) is an autoimmune neurologic disease characterized by abnormal neuromuscular transmission. Thymic mass screening with chest multidetector computed tomography (MDCT) disclosed prominent soft tissue at mid-superior mediastinum without abnormal enhancement, measured about 0.98 cm x 2.29 cm in its greatest transverse dimension (Figure 1) She has been maintained on 5-mg prednisolone three tablets every other day and 60-mg pyridostigmine two tablets thrice a day, with stable symptoms at the Myasthenia Gravis Foundation of America (MGFA) class IIa. She has been maintained on 5-mg prednisolone three tablets every other day and 60-mg pyridostigmine two tablets thrice a day, with stable symptoms at the Myasthenia Gravis Foundation of America (MGFA) class IIa She received the first and second doses of the BNT162b2 COVID-19 vaccine approximately four weeks and eight days prior to the scheduled thymectomy. At a two-week follow-up, the patient reported improvement of muscle strength, the disappearance of diplopia, a normal voice, and having regular daily activities

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