Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy.
School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Neurol Sci. 2022 Oct;43(10):5799-5802. doi: 10.1007/s10072-022-06284-5. Epub 2022 Jul 23.
Myasthenia gravis (MG) is an autoimmune disease that targets acetylcholine receptor (AChR) of the neuromuscular junction. New-onset MG after SARS-CoV-2 vaccination has rarely been reported.
We report about three patients who presented new-onset myasthenia gravis after receiving mRNA SARS-CoV-2 vaccination. The patients were all males and older than 55 years. All the patients presented with ocular and bulbar symptoms. The interval between vaccine administration and MG onset ranged from 3 days after the first dose to 10 days after the second dose. All the patients had elevated serum AChR antibodies and responded to pyridostigmine. Two out of three patients were successfully treated with IVIG or plasma exchange and with long-term immunosuppression.
MG is a rare disease; clinicians should be aware of possible new-onset MG after SARS-CoV-2 vaccination, especially with the current recommendation of booster doses. The hyperstimulation of the innate immune system or the exacerbation of a subclinical pre-existing MG could be possible explanations.
重症肌无力（MG）是一种自身免疫性疾病，其靶标为神经肌肉接头处的乙酰胆碱受体（AChR）。SARS-CoV-2 疫苗接种后新发重症肌无力极为罕见。
我们报告了 3 例接种 mRNA SARS-CoV-2 疫苗后新发重症肌无力的患者。3 例患者均为男性，年龄均大于 55 岁。所有患者均表现为眼肌和球肌症状。从第一针疫苗接种到第二针疫苗接种后第 10 天，患者从疫苗接种后第 3 天到 MG 发病的时间间隔各不相同。所有患者的血清 AChR 抗体均升高，对吡啶斯的明有反应。3 例患者中的 2 例接受 IVIG 或血浆置换联合长期免疫抑制治疗后成功治愈。
MG 是一种罕见疾病；临床医生应注意 SARS-CoV-2 疫苗接种后可能新发的 MG，尤其是目前推荐加强针接种后注意这种疾病。先天免疫系统的过度刺激或亚临床存在的 MG 加重可能是其发病原因。
