Background: COVID-19 was initially described to affect the respiratory system, it is now known to affect other systems and present in a myriad of ways. This has often proved to be a diagnostic and therapeutic challenge to clinicians and stretched healthcare resources, sometimes with poor outcomes. We report on an atypical presentation of SARS-CoV-2 infection as an acute exacerbation of myasthenia gravis in a low resource setting. Case Presentation: A middle aged male with myasthenia gravis presented with a three weeks’ history of worsening generalized weakness and three days’ history of new-onset dysphagia with no history of fever and cough. After a few days of apparent improvement, the patient developed progressive respiratory distress. Further evaluation confirmed bilateral pneumonia and COVID-19. Conclusion: There is a need for clinicians and health service providers to have a low threshold for suspicion and testing for COVID-19 in patients with pre-existing medical conditions and immunomodulatory therapy such as Myasthenia gravis.
References
[1]
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., et al. (2020) Clinical Features of Patients Infected with 2019 Novel Coronavirus in Wuhan, China. The Lancet, 395, 497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
[2]
Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., Qiu, Y., Wang, J., Liu, Y., Wei, Y., Yu, T., et al. (2020) Epidemiological and Clinical Characteristics of 99 Cases of 2019 Novel Coronavirus Pneumonia in Wuhan, China: A Descriptive Study. The Lancet, 395, 507-513. https://doi.org/10.1016/S0140-6736(20)30211-7
[3]
Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., Zhao, X., Huang, B., Shi, W., Lu, R., Niu, P., et al. (2020) A Novel Coronavirus from Patients with Pneumonia in China, 2019. New England Journal of Medicine, 382, 727-733. https://doi.org/10.1056/NEJMoa2001017
[4]
Holshue, M.L., DeBolt, C., Lindquist, S., Lofy, K.H., Wiesman, J., Bruce, H., Spitters, C., Ericson, K., Wilkerson, S., Tural, A., Diaz, G., et al. (2020) First Case of 2019 Novel Coronavirus in the United States. New England Journal of Medicine, 382, 929-936. https://doi.org/10.1056/NEJMoa2001191
[5]
Paterson, R.W., Brown, R.L., Benjamin, L., Nortley, R., Wiethoff, S., Bharucha, T., Jayaseelan, D.L., Kumar, G., Raftopoulos, R.E., Zambreanu, L., Vivekanandam, V., et al. (2020) The Emerging Spectrum of COVID-19 Neurology: Clinical, Radiological and Laboratory Findings. Brain, 143, 3104-3120. https://doi.org/10.1093/brain/awaa240
[6]
Maury, A., Lyoubi, A., Peiffer-Smadja, N., De Broucker, T. and Meppiel, E. (2021) Neurological Manifestations Associated with SARS-CoV-2 and Other Coronaviruses: A Narrative Review for Clinicians. Revue Neurologique, 177, 51-64. https://doi.org/10.1016/j.neurol.2020.10.001
[7]
Harapan, B.N. and Yoo, H.J. (2021) Neurological Symptoms, Manifestations, and Complications Associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Coronavirus Disease 19 (COVID-19). Journal of Neurology, 268, 3059-3071. https://doi.org/10.1007/s00415-021-10406-y
[8]
Beghi, E., Giussani, G., Westenberg, E., Allegri, R., Garcia-Azorin, D., Guekht, A., Frontera, J., Kivipelto, M., Mangialasche, F., Mukaetova-Ladinska, E.B., Prasad, K., et al. (2022) Acute and Post-Acute Neurological Manifestations of COVID-19: Present Findings, Critical Appraisal, and Future Directions. Journal of Neurology, 269, 2265-2274. https://doi.org/10.1007/s00415-021-10848-4
[9]
Atamenta, T., Cherie, A. and Alemu, W. (2022) Time to Death and Its Predictors among Adult Patients with COVID-19: A Retrospective Cohort Study in Ethiopia. Frontiers in Epidemiology, 2, Article 1065184. https://doi.org/10.3389/fepid.2022.1065184
[10]
Marschner, I.C. (2021) Estimating Age-Specific COVID-19 Fatality Risk and Time to Death by Comparing Population Diagnosis and Death Patterns: Australian Data. BMC Medical Research Methodology, 21, Article No. 126. https://doi.org/10.1186/s12874-021-01314-w
[11]
Anand, P., Slama, M.C., Kaku, M., Ong, C., Cervantes-Arslanian, A.M., Zhou, L., David, W.S. and Guidon, A.C. (2020) COVID-19 in Patients with Myasthenia Gravis. Muscle & Nerve, 62, 254-258. https://doi.org/10.1002/mus.26918
[12]
Delly, F., Syed, M.J., Lisak, R.P. and Zutshi, D. (2020) Myasthenic Crisis in COVID-19. Journal of the Neurological Sciences, 414, Article ID: 116888. https://doi.org/10.1016/j.jns.2020.116888
[13]
Singh, S. and Govindarajan, R. (2020) COVID-19 and Generalized Myasthenia Gravis Exacerbation: A Case Report. Clinical Neurology and Neurosurgery, 196, Article ID: 106045. https://doi.org/10.1016/j.clineuro.2020.106045
