SHM Converge Scientific Abstract ePoster Gallery-A Case of Myasthenic Crisis Following Covid-19 Vaccine

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This case report describes a 72-year-old woman who developed myasthenic crisis shortly after receiving her second Moderna COVID-19 vaccine dose. She had no known prior history of myasthenia gravis, but presented one and a half weeks after vaccination with one week of worsening fatigue and shortness of breath. On exam, she had rapid shallow breathing, proximal muscle weakness, and neck flexor weakness. She also developed bilateral ptosis that improved with an ice-pack test, supporting a diagnosis of myasthenia gravis.<br /><br />Her respiratory function worsened, with declining negative inspiratory force and vital capacity, so she was electively intubated for impending respiratory failure. A workup ruled out other common triggers and alternate diagnoses, including acute coronary syndrome, COVID-19 infection, pulmonary embolism, thymoma, and other infections. Imaging showed only lung hypoinflation and peridiaphragmatic atelectasis.<br /><br />Given strong suspicion for myasthenia gravis, she was treated with plasma exchange and pyridostigmine. Serologic testing later confirmed the diagnosis, showing positive acetylcholine receptor binding, blocking, and modulating antibodies, as well as a positive anti-striated muscle antibody. She was then started on prednisone and mycophenolate mofetil. Her condition improved, she was extubated successfully, and she was transferred to rehabilitation.<br /><br />The authors concluded that, in the absence of any other identifiable trigger, the myasthenic crisis was likely precipitated by recent COVID-19 vaccination. They note that myasthenic crisis as an initial presentation of myasthenia gravis after COVID-19 vaccination is rare and that more case reports are needed to better determine whether there is any true association and to estimate its incidence.

Asset Subtitle

Asmi Chattaraj

Meta Tag

Author List Asmi Chattaraj, Jad Sallit, Jonathan Arnold

Category Clinical Vignettes

Concept Myasthenic Crisis

Concept Myasthenia Gravis

Concept Fatigable Weakness

Concept Airway Protection

Concept Intubation

Distinguished Non-Finalist

Presenter Organization UPMC McKeesport

Presenting Author Asmi Chattaraj

Track Adult

Keywords

myasthenic crisis

myasthenia gravis

COVID-19 vaccination

Moderna vaccine

acetylcholine receptor antibodies

ptosis

respiratory failure

plasma exchange

pyridostigmine

case report

Myasthenic Crisis

Myasthenia Gravis

Fatigable Weakness

Airway Protection

Intubation