Transient acetylcholine receptor-related myasthenia gravis, post multisystem inflammatory syndrome in children (MIS-C) temporally associated with COVID-19 infection

Farida Essajee; Juanita Lishman; Regan Solomons; Deepthi Raju Abraham; Pierre Goussard; Ronald Van Toorn

doi:10.1136/bcr-2021-244102

Transient acetylcholine receptor-related myasthenia gravis, post multisystem inflammatory syndrome in children (MIS-C) temporally associated with COVID-19 infection

BMJ Case Rep. 2021 Aug 11;14(8):e244102. doi: 10.1136/bcr-2021-244102.

Authors

Farida Essajee¹, Juanita Lishman¹, Regan Solomons¹, Deepthi Raju Abraham¹, Pierre Goussard², Ronald Van Toorn¹

Affiliations

¹ Pediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.
² Pediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa pgouss@sun.ac.za.

Abstract

We report on a unique case of a 7-year-old girl with new onset ocular myasthenia gravis shortly after recovery from multisystem inflammatory syndrome in children (MIS-C) temporally associated with SARS-CoV-2 infection. The diagnosis of myasthenia gravis was based on suggestive symptoms of fatigable bilateral orbital ptosis, diplopia, positive ocular cold compression test and serum acetylcholine receptor antibody positivity, as well as a favourable treatment response to pyridostigmine. The addition of corticosteroids and methotrexate resulted in complete resolution of the ocular signs.

Keywords: COVID-19; neuroimaging; neurology (drugs and medicines); neuromuscular disease; paediatrics (drugs and medicines).

Publication types

Case Reports

MeSH terms

COVID-19*
Child
Female
Humans
Myasthenia Gravis* / complications
Myasthenia Gravis* / diagnosis
Myasthenia Gravis* / drug therapy
Receptors, Cholinergic
SARS-CoV-2
Systemic Inflammatory Response Syndrome

Substances

Receptors, Cholinergic

Supplementary concepts

pediatric multisystem inflammatory disease, COVID-19 related