Pediatric Infectious Disease

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VOLUME 5 , ISSUE 1 ( January-March, 2023 ) > List of Articles

CASE REPORT

Juvenile Autoimmune Myasthenia Gravis due to Thymoma Following Coronavirus Disease 2019 Infection in a Child

Vykuntaraju K Gowda, Varsha Reddy, KVN Dhananjaya, Usha Amirtham

Keywords : Acetylcholine receptor antibodies, Coronavirus disease 2019 infection, Gravis, Myasthenia, Thymoma

Citation Information : Gowda VK, Reddy V, Dhananjaya K, Amirtham U. Juvenile Autoimmune Myasthenia Gravis due to Thymoma Following Coronavirus Disease 2019 Infection in a Child. Pediatr Inf Dis 2023; 5 (1):20-22.

DOI: 10.5005/jp-journals-10081-1386

License: CC BY-NC 4.0

Published Online: 15-04-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Introduction: The acquired myasthenia gravis (MG) is an autoimmune neuromuscular junction (NMJ) disorder. Thymomas and thymic carcinomas are extremely rare in children. We are reporting a rare case of MG following the coronavirus disease 2019 (COVID-19) infection. Case description: A 10-year-old girl presented with difficulty in getting up from sitting, swallowing, and drooping of eyelids. Weakness was more in the evening. On examination, bilateral ptosis had a power of 2/5 in the proximal and 3/5 in the distal group of muscle. There was a history of COVID-19 infection 45 days ago. Investigations revealed a decremental response in repetitive nerve stimulation. The neostigmine challenge test noted improvement in ptosis and weakness. Computed tomography (CT) showed a large thymic lesion. Antibody to the acetylcholine receptor (AChR) and COVID-19 spike protein was positive. Treated with oral pyridostigmine, steroids, and thymectomy, and showed significant improvement in power. Histopathology of the excised mediastinal mass revealed type B2 thymoma. Conclusion: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can precipitate MG in the underlying thymoma.


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  1. Drachman DB. Myasthenia gravis. N Engl J Med 1994;330(25):1797–1810. DOI: 10.1056/NEJM199406233302507
  2. Hoch W, McConville J, Helms S, et al. Auto-antibodies to the receptor tyrosine kinase MuSK in patients with myasthenia gravis without acetylcholine receptor antibodies. Nat Med 2001;7(3):365–368. DOI: 10.1038/85520
  3. Roxanis I, Micklem K, Willcox N. True epithelial hyperplasia in the thymus of early-onset myasthenia gravis: implications for immunopathogenesis. J Neuroimmunol 2001;112(1–2):163–173. DOI: 10.1016/s0165-5728(00)00415-x
  4. Stachowicz-Stencel T, Bien E, Balcerska A, et al. Thymic carcinoma in children: a report from the polish pediatric rare tumors study. Pediatr Blood Cancer 2010;54(7):916–920. DOI: 10.1002/pbc.22482
  5. Ramaswamy SB, Govindarajan R. COVID-19 in refractory myasthenia gravis- a case report of successful outcome. J Neuromuscul Dis 2020;7(3):361–364. DOI: 10.3233/JND-200520
  6. Anand P, Slama MCC, Kaku M, et al. COVID-19 in patients with myasthenia gravis. Muscle Nerve 2020;62(2):254–258. DOI: 10.1002/mus.26918
  7. Saha A, Batra P, Vilhekar KY, et al. Post-varicella myasthenia gravis. Singapore Med J 2007;48(6):e177–e180. PMID: 17538742. PMID: 17538742.
  8. Felice KJ, DiMario FJ, Conway SR. Postinfectious myasthenia gravis: report of two children. J Child Neurol 2005;20(5):441–444. DOI: 10.1177/08830738050200051501
  9. Schwimmbeck PL, Dyrberg T, Drachman DB, et al. Molecular mimicry and myasthenia gravis. J Clin Invest 1989;84(4):1174–1180. DOI: 10.1172/JCI114282
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