Postinfectious Myasthenia Gravis: Report of two Children

Abstract

We report two children with transient myasthenia gravis preceded by viral illnesses. The first is a 5-year-old boy who developed oculobulbar weakness 2 weeks following a varicella-zoster infection. The second is a 4-year-old boy who developed facial diplegia and dysarthria several weeks following a viral pharyngitis. Myasthenia gravis was diagnosed based on the substantial decremental changes on 3 Hz repetitive motor nerve stimulation studies for the first child and on the positive edrophonium test and complete improvement in symptoms during pyridostigmine therapy for both children. In both cases, the symptoms gradually resolved and have not recurred following discontinuation of pyridostigmine. Molecular mimicry between the acetylcholine receptor and viral proteins might provide the nidus for the immune response in this variant of myasthenia gravis. (J Child Neurol 2005;20:441—444.)

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References

Drachman DB : Myasthenia gravis. N Engl J Med 1994 ;330:1797—1810.

Engel AG (ed): Myasthenia Gravis and Myasthenic Disorders. New York, Oxford University Press, 1999.

Evoli A. , Tonali PA , Padua L. , et al: Clinical correlates with anti-MuSK antibodies in generalized seronegative myasthenia gravis. Brain 2003 ;126:2304—2311.

Grob D. Natural history of myasthenia gravis, in Engel AG (ed): Myasthenia Gravis and Myasthenic Disorders . New York, Oxford University Press , 1999, 131—145.

Lubetzki Korn I. , Abramsky O. : Myasthenia gravis following viral infection . Eur Neurol 1981;20:435—439.

Authier FJ , De Grissac N. , Degos JD , Gherardi RK : Transient myasthenia gravis during HIV infection. Muscle Nerve 1995;18:914—916.

Fukui T. , Sugita K. , Ichikawa H. , et al: Human T lymphocytic virus type 1 associated myelopathy and myasthenia gravis: A possible association. Eur Neurol 1994;34:158—161.

Verma A. , Berger JR : Myasthenia gravis associated with dual infection of HIV and HTLV-1 . Muscle Nerve 1995;18:1355—1356.

Schwimmbeck PL , Dyrberg T. , Drachman DB , Oldstone Mba. Molecular mimicry and myasthenia gravis: An autoantigenic site on the acetylcholine receptor α-subunit that has biologic activity and reacts immunochemically with herpes simplex virus. J Clin Invest 1989;84:1174—1180.

10.

Stefansson K. , Dieperink ME , Richman DP , et al: Sharing of antigenic determinants between the nicotinic acetylcholine receptor and proteins in Escherichia coli, Proteus vulgaris, and Klebsiella pneumoniae: Possible role in the pathogenesis of myasthenia gravis. N Engl J Med 1985;312:221—225.