West nile virus infection and myasthenia gravis

A. Arturo Leis, Gabriella Szatmary, Mark A. Ross, Dobrivoje S. Stokic

Research output: Contribution to journalArticle

30 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)26-29
Number of pages4
JournalMuscle and Nerve
Volume49
Issue number1
DOIs
StatePublished - Jan 1 2014

Keywords

  • Autoimmunity
  • Molecular mimicry
  • Myasthenia gravis
  • Neuromuscular junction
  • Poliomyelitis
  • West Nile virus

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Cellular and Molecular Neuroscience
  • Physiology (medical)

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