Transient Myasthenia Gravis Research Articles

Transient myasthenia gravis as a complication of COVID-19 in a 1.5-year-old boy: a case report and literature review

SARS-CoV-2 infection often causes neurological symptoms and complications. Those associated with the production of anti-acetylcholine receptor antibodies are rare. The aim of the study was to present a case of transient myasthenia gravis as a possible complication of COVID-19. A 1.5-year-old boy was admitted on day 7 of varicella due to poor general condition and anuria. On examination, he presented with dehydration, fatigue, sleepiness, and bilateral ptosis. High titre of serum anti-SARS-CoV-2 antibodies was revealed with a history of viral infection 2 weeks prior. An initial diagnosis of encephalitis was made and treatment was started. Despite clinical improvement, gait disturbances and ptosis persisted and the boy was sent for further neurological evaluation. High titre of anti-acetylcholine receptor antibodies (2.98 nmol/L; normal <0.50 nmol/L) confirmed myasthenia gravis, but no treatment was started. Symptoms and antibodies resolved after 3 and 4 months, respectively. A follow-up after one year showed no recurrences. Conclusion: Transient, self-limiting myasthenia gravis may develop in a child as a complication of viral infection, including COVID-19.

A rare case of myasthenia gravis in pregnancy with impending eclampsia

Managing myasthenia gravis during pregnancy is challenging due to its high-risk nature, particularly among women aged 20 to 30, coinciding with childbearing age. This risk is exacerbated when myasthenia gravis coexists with pregnancy-induced hypertension, leading to an increased threat of morbidity and mortality for both the mother and the fetus.This case report highlights the challenges associated with simultaneous occurrence of myasthenia gravis and pregnancy-induced hypertension, leading to impending eclampsia. Employing a multidisciplinary approach involving obstetricians, neurologists, anesthesiologists, and neonatologists was pivotal in addressing the complexities presented. An emergency cesarean section at the eighth month addressed worsening pre-eclampsia and respiratory distress. Strategic administration of a bolus of steroids and pyridostigmine, coupled with the use of cardiac-stable ropivacaine for spinal anesthesia, contributed to a successful procedure. Post-delivery, neonatal observation confirmed the absence of transient myasthenia gravis, with subsequent normal follow-up examinations for both mother and baby. This case underscores the need for a comprehensive approach in managing these uncommon but high-risk conditions during pregnancy.

Transient Neonatal Myasthenia Gravis: Case Report

Purpose: Transient neonatal myasthenia gravis (NMG) results from the transplacental transfer of antibodies of mothers with an autoimmune form of myasthenia gravis. The clinical presentation develops in 10%–20% of their children. This study aimed to present a case of a newborn with transient myasthenia gravis (MG) born to a mother diagnosed with MG.
 Case presentation: The disease manifested itself as generalized hypotonia, weak cry, respiratory distress, poor sucking, and facial diplegia. The symptoms were usually self-limiting, and transient supportive treatment was required. A diagnostic test was a good clinical response of the child to the administration of an acetylcholinesterase inhibitor. After the clearance of antibodies from the child's blood, long-term therapy was not necessary and the disease resolved. Treatment was supportive and included the administration of smaller and more frequent meals via a tube, noninvasive or invasive support of respiratory function, and use of acetylcholinesterase inhibitors (neostigmine and pyridostigmine).
 Conclusion: Pediatric patients diagnosed with transient NMG are extremely rare in everyday clinical practice, and hence it is important to be familiar with it.

Fetal Surveillance in Pregnancies with Myasthenia Gravis.

Myasthenia gravis (MG) is an autoimmune condition, that commonly impacts adult women of reproductive age. Myasthenia gravis in pregnancy is rare, but the incidence is higher in different geographical areas. Pregnancies in mothers with MG can have an unfortunate outcome. Acetylcholine receptor antibodies may pass into the fetal circulation and can affect the fetal neuromuscular junction, generating transient MG or even fetal arthrogryposis. The 2016 and 2021 International Consensus Guidance for Management of Myasthenia Gravis issued by Myasthenia Gravis Foundation of America is lacking in recommendation for fetal surveillance for pregnancies in women with MG. The aim of this paper is to highlight fetal and neonatal complications in mothers with MG and to offer antenatal care insights. Close maternal and pregnancy monitoring can improve pregnancy outcome. Patients with MG should be encouraged to conceive, to avoid triggers for exacerbations of the disease during pregnancy and a multidisciplinary team should be established to ensure the optimal support and therapy.

SAT-108 Growth Hormone Deficiency in a Patient with Ectodermal Dysplasia

Background information:Ectodermal dysplasia (ED) is a rare heterogeneous group of genetic disorders of ectodermal derived tissues, characterized by abnormalities in skin, teeth, hair and eccrine glands. Growth failure in these children varies depending on the genetic mutation and has not been well characterized. This clinical case report presents a 11-year-old male with a heterozygous mutation in WNT 10 A, a variant of the hypohydrotic ED gene, who was found to have growth hormone (GH) deficiency and treated with GH.Case report:He was born at 35 weeks gestation by C-section with a birth weight of 5 lbs. 12 oz. to a mother who had invitro fertilization with donor eggs from the maternal aunt with ocular myasthenia gravis and sperm from the father. Pregnancy was complicated by twin gestation and polyhydraminos. He had transient myasthenia gravis and treated with pyridostigmine for 3 months for feeding problems and swallowing difficulty. He also had arthrogryposis of the distal upper extremities attributed to placental transfer of the maternal aunt’s myasthenia gravis antibodies.He was referred to the endocrine clinic for evaluation of his growth failure around the age of 8 years. His growth chart indicated that he grew along the 5thpercentile until age 5 year with a gradual decline to the 3rd percentile by age 7 year and close to 2nd percentile by age 8 year. His BMI was at 7th percentile. Mid parental height was 5’9”. There was no history of delayed adolescence in the family. His twin sister had very mild form of arthrogryposis with dental delay but steady linear growth. He also had decreased exercise tolerance. His body tended to become hot during sports activities and had to wrap his face and neck with cold soaked towels. His other problems included delayed dental development with conical incisor, thin nail, missing teeth and hearing defects that raised suspicion for ectodermal dysplasia. Genetic testing at the age of 4 years had demonstrated a heterozygous mutation in the WNT 10A gene, an important gene for tooth development. Physical examination revealed a mild facial dysmorphism with conical incisor, missing teeth and high arched palate. He had contracture of the proximal inter phalangeal joints of the hands. Investigations revealed a normal thyroid function test, IGF-1 and IGFBP-3 level, CBC, sedimentation rate, chemistry panel and celiac titer. The bone age was concordant with his chronological age of 8 years. A GH stimulation study demonstrated a peak GH level of 4.94 ng/ml. An MRI of the brain revealed a normal pituitary gland. He was started on GH therapy with 0.3 mg/kg/week at age 9 year. His height improved from 2nd percentile at age 9 year to 20th percentile by age 11 year on growth hormone therapy. His exercise capacity and stamina also improved.Conclusion:Growth failure and GH axis should be evaluated in children with ED. GH therapy improves growth velocity and exercise capacity in patients with ED.

Neonatal transient myasthenia gravis and a case with intestinal perforation

Transient neonatal myasthenia gravis (MG) is observed in babies born to mothers with MG. Hypotony and respiratory distress are the most important warning signs observed in these babies. Anticholinesterases are used in the treatment. In this study, we present a case diagnosed with transient neonatal MG that has developed intestinal perforation after neostigmine treatment.

Neonatal Lupus Erythematosus Associated with Unilateral Pectoralis Major Atrophy

Neonatal lupus erythematosus (NLE), in most cases, presents with cardiac and dermatological manifestation due to transferred IgG auto antibodies (anti Ro/SSA and anti La/SSB) from the mother. Some unusual associations with myelopathy, vasculopathy, transient myasthenia gravis, congenital nephrotic syndrome, chondrodysplasia punctata etc. are also reported. Here, the authors present a case of NLE with isolated left sided pectoralis major muscle atrophy, which has not been reported earlier.

Marked Hypotonia in an Infant of a Mother With Devic Disease

A full-term female neonate was born with severe hypotonia and weakness. Her mother had been treated for neuromyelitis optica (Devic disease) for 6 years. Her previous son, born 10 years earlier and before she developed the disease, also had marked hypotonia that gradually improved over several weeks. A suspicion of neonatal myasthenia gravis arose, as a search of the literature revealed the occasional detection of anti-acetylcholine receptor antibodies in patients with Devic disease. A neostigmine test was mildly positive in the baby, but anti-acetylcholine receptor antibodies were elevated. Aquaporin 4 antibodies typical of neuromyelitis optica were not detected in the infant. Because of clinical deterioration, intravenous immunoglobulin was administered with substantial improvement. Anti-acetylcholine antibodies were markedly elevated in the mother's serum, although she showed no clinical signs of myasthenia gravis. It is very likely that her previous baby also had unrecognized transient myasthenia gravis.

Postinfectious Myasthenia Gravis: Report of two Children

We report two children with transient myasthenia gravis preceded by viral illnesses. The first is a 5-year-old boy who developed oculobulbar weakness 2 weeks following a varicella-zoster infection. The second is a 4-year-old boy who developed facial diplegia and dysarthria several weeks following a viral pharyngitis. Myasthenia gravis was diagnosed based on the substantial decremental changes on 3 Hz repetitive motor nerve stimulation studies for the first child and on the positive edrophonium test and complete improvement in symptoms during pyridostigmine therapy for both children. In both cases, the symptoms gradually resolved and have not recurred following discontinuation of pyridostigmine. Molecular mimicry between the acetylcholine receptor and viral proteins might provide the nidus for the immune response in this variant of myasthenia gravis.

Transient myasthenia gravis during HIV infection

Transient myasthenia gravis during HIV infection

Myasthenia gravis in children and anaesthetic management for thymectomy.

Records of 22 patients with myasthenia gravis treated at The Hospital for Sick Children, Toronto, between January 1957 and March 1972 were reviewed. Three cases of neonatal transient myasthenia gravis were treated with anticholinesterase drugs. Eleven patients with juvenile generalized myasthenia gravis and one with neonatal persistent myasthenia gravis underwent thymectomy. The discontinuation of anticholinesterase treatment for at least 24 hours prior to operation and the use of small doses of edrophonium in the first four post-operative days decrease the incidence of complications. Complete remission occurred in four cases and objective improvement in eight. Thymectomy without elective tracheostomy is only possible with 24-hour intensive care facilities and constant medical supervision.