MYASTHENIA-LIKE PRESENTATION POST COVID-19 VACCINE
Published 2022 - 26th ESCRS Winter Meeting
Reference: P264 | Type: Abstracts | DOI: 10.82333/x5bn-hb74
Authors: Maria Rizk* 1 , Ama Sadaka 1
1Ophthalmology Department,Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon,Beirut,Lebanon
Purpose
The purpose of this report is to shed light on the possible multisystem inflammatory reaction caused by COVID vaccine. This reaction can mimic auto-immune disease like mysathenia gravis and patients can present to the ophthalmolgist clinic.
Setting
A 35-year old previously healthy patient presented to our ophthalmology clinic with left fluctuating ptosis, binocular diplopia, slurred speech, diffiulty swallowing, and staggered gait two days after his second dose of COVID vaccine (Pfizer-BioNTech mRNA vaccine). No fever, no cough, no other associated symptoms. A Covid PCR was done elsewhere and was negative.
Methods
Ophthalmological exam and neurological exam were completed. MRI brain with and without gadolinium was ordered. Blood tests including acetylcholine receptor antibodies (AChR Ab), TSH, Thyrotropin Receptor Antibody (TRAb), and ESR,were ordered.
Results
Ophthalmology exam showed best corrected visual acuity 20/20 both eyes, pupils were equal and reactive, there was no relative afferent pupillary defect, intraocular pressure was normal both eyes. Left ptosis was present and it was fatigable. Motility was full both eyes, no restriction of extra ocular muscles. Color vision was normal both eyes. Slit lamp exam and dilated fundus exam were normal both eyes.
Blood tests including AChR Ab and TRAb came back within normal ranges, and MRI brain with and without contrast was also normal.
The patient was monitored and observed closely, and his symptoms gradually resolved over the course of 2 weeks, and eventually returned to normal, without any intervention.
It was speculated that the myasthenia-like presentation of this patient post second shot of COVID vaccine was triggered by a multisystem inflammatory reaction post vaccine. A report of myasthenia gravis is described in the litterature concomitantly with a positive Covid PCR result. However, to our knowledge, this is the first case of mysathenia like symptoms happening post Covid vaccination.
Conclusion
This report comes to shed light on an important complication of Covid vaccine. This is important for ophthalmologists to know, because it can help both the patients and the doctor in the management.
The etiology is speculated to be either due to an autoimmune stimulation, or due to a cross reaction of SARS-Cov 2 proteins with AChR in the body.