Dear Editor,
We would like to thank you for the opportunity to respond to the issues raised in the letter and to clarify aspects of our study about these concerns. We would also like to thank the authors for their interest in our paper and for taking the time to express their observations.[1]
The authors want to know the exact onset of the symptoms of our case in this report. In our case, the patient had presented with drooping eyelids for the past 10 days. There was a preceding episode of SARS-CoV-2 infection 1 month (43 days to be precise) back. It took him 3 weeks to recover. We would like to clarify that there was no history of hospital admission in our case. The symptoms developed after his complete recovery.
We appreciate the authors for the detailed analysis of this case. Ocular myasthenia gravis (OMG) usually presents with ptosis and diplopia. According to the existing literature, a significant percentage of patients with OMG do not have any detectable antibodies in the blood assay.[2,3] In other words, elevated serum anti-AChR antibody is less sensitive and more specific in diagnosing OMG. Given this, the chance of asymptomatic OMG with preexisting elevated antibodies looks remote.
The facial nerve was stimulated for low-frequency repetitive stimulation. We thank the authors for pointing that to us.
SARS-CoV-2 infection was mild in this patient. He was kept in home isolation and treated conservatively with pyrigesic in case of fever and anti-oxidant medications. We completely agree with the authors on the importance of eliciting drug history in these cases.
His serum C-reactive protein was raised during the SARS-CoV-2 infection which became normal during the recovery phase.
We agree with the authors that the course of the disease and assessment of anti-AChR antibody at various stages of the disease would have unveiled important information; however, it was beyond the scope of the clinical image as it would have needed longer follow-up.
There are reports of OMG following COVID-19 vaccination.[4] However, there was no such history in our patient.
We respect the authors’ point of view. We ensure that after a detailed history and considering all the predisposing factors, we have come to the diagnosis of new-onset OMG secondary to SARS-CoV-2 in this case.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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