PDF(Pubmed)
Abstract：
Myasthenia gravis (MG) is a rare autoimmune disease that is potentially threatening for patient life. Auto-antibodies targeting structures of the neuromuscular junction, particularly the acetylcholine receptor (AchR), are often found in the serum of MG patients. New-onset MG after SARS-CoV-2 vaccination has rarely been reported since the introduction of vaccination. Infections and COVID-19 infection have also been reported as possible triggers for a myasthenic crisis. We report a case of new-onset MG after receiving the mRNA COVID-19 vaccination. The patient was a 73-year-old male initially presenting with ocular symptoms and a rapid generalization. We also performed a literature revision of 26 described cases of MG after SARS-CoV-2 immunization. The patients were a majority of males with generalized late-onset MG occurring after the first dose of vaccine, similar to our patient. Only our patient showed a thymoma. Thymic mass and the positivity of AchR antibodies suggest that vaccination might have triggered a subclinical pre-existing MG with symptoms flaring. Clinicians should be aware of possible new-onset MG after COVID-19 vaccination, particularly in at-risk patients. Even though COVID-19 vaccination should be recommended in MG patients, particularly in well-compensated patients. However, more studies need to be performed in the future.
摘要：
重症肌无力（MG）是一种罕见的自身免疫性疾病，可能威胁患者的生命。针对神经肌肉接头结构的自身抗体，特别是乙酰胆碱受体（AchR），常存在于MG患者的血清中。自从引入疫苗接种以来，很少有报道在SARS-CoV-2疫苗接种后出现新的MG。据报道，感染和COVID-19感染可能是肌无力危机的诱因。我们报告了一例接受COVID-19mRNA疫苗接种后新发MG的病例。该患者是一名73岁的男性，最初表现为眼部症状并迅速普及。我们还对SARS-CoV-2免疫后的26例MG进行了文献修订。患者大多数是男性，在第一剂疫苗后出现广泛性迟发性MG，和我们的病人相似.只有我们的病人出现胸腺瘤。胸腺质量和AchR抗体的阳性表明，疫苗接种可能引发了亚临床先前存在的MG，症状明显。临床医生应该意识到COVID-19疫苗接种后可能出现的新发MG，特别是在有风险的患者中。尽管应建议MG患者接种COVID-19疫苗，特别是在补偿良好的患者中。然而,未来需要进行更多的研究。
