Remission of myasthenia gravis following infection with SARS-CoV-2

Abstract This case report describes an unprecedented remission of ocular Myasthenia Gravis (MG) in a 3-year-old girl following a SARS-CoV-2 infection. Both MG and SARS-CoV-2 influence the cholinergic system, and this case underscores the importance of considering multiple factors in autoimmune disorders and the potential impact of viral infections on their course. The patient initially presented with ptosis and limited eye movement. Her diagnosis of seronegative MG was confirmed with abnormal visual evoked potentials and positive response to pyridostigmine. Her ptosis and limited extraocular muscle movement were intermittent until 2 years later when she tested positive for SARS-CoV-2 for which no antiviral medication was taken. Unexpectedly, her MG symptoms rapidly improved postinfection, leading to the cessation of pyridostigmine. This case highlights the complex interplay between MG, viral infections, and the influence of anti-acetylcholine receptor antibodies, second-hand smoke, and natural nicotinic agonists from the use of pyridostigmine on the cholinergic system.