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Muscle Nerve. 2014 Jan;49(1):26-9. doi: 10.1002/mus.23869. Epub 2013 Sep 11.

West nile virus infection and myasthenia gravis.

Author information

1
Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson, Suite 2, Jackson, Mississippi, 39216, USA.

Abstract

INTRODUCTION:

Viruses are commonly cited as triggers for autoimmune disease. It is unclear if West Nile virus (WNV) initiates autoimmunity.

METHODS:

We describe 6 cases of myasthenia gravis (MG) that developed several months after WNV infection. All patients had serologically confirmed WNV neuroinvasive disease. None had evidence of MG before WNV.

RESULTS:

All patients had stable neurological deficits when they developed new symptoms of MG 3 to 7 months after WNV infection. However, residual deficits from WNV confounded or delayed MG diagnosis. All patients had elevated acetylcholine receptor (AChR) antibodies, and 1 had thymoma. Treatment varied, but 4 patients required acetylcholinesterase inhibitors, multiple immunosuppressive drugs, and intravenous immune globulin or plasmapheresis for recurrent MG crises.

CONCLUSIONS:

The pathogenic mechanism of MG following WNV remains uncertain. We hypothesize that WNV-triggered autoimmunity breaks immunological self-tolerance to initiate MG, possibly through molecular mimicry between virus antigens and AChR subunits or other autoimmune mechanisms.

KEYWORDS:

West Nile virus; autoimmunity; molecular mimicry; myasthenia gravis; neuromuscular junction; poliomyelitis

PMID:
23559196
DOI:
10.1002/mus.23869
[Indexed for MEDLINE]

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