TABLE 2.
MG worsening after vaccination
| Sex/age, years | Type of antibody |
Max MGFA |
Disease duration at first dose, years | Thymoma/autoimmune comorbidity | Doses received, n | Dose number causing worsening (type) | Immune therapy at first vaccine dose | MG symptoms at worsening | Vaccine doses after MG worsening | MG symptoms at following doses | Outcome | PIS at first vaccine dose | PIS at last FU |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| M, 60 | AChR | V | 15 | No/vitiligo | 2 | First (Pfizer) | AZA | Upper limbs weakness | 1 (second, Pfizer) | None | Spontaneous regression after 2 months | MM | MM |
| F, 59 | Seronegative | IIIB | 18 | Yes/no | 3 | First (Moderna) and second (Moderna) | CS, CyA | Four limbs weakness, bulbar symptoms, diplopia | 2 (second, Moderna; third, Pfizer) | Four limbs weakness, bulbar symptoms, diplopia after second dose; none after third dose | Spontaneous regression (first); regression after increasing steroids (second) | MM | MM |
| F, 34 | MuSK | IIB | 2 | No/no | 2 | First (Pfizer) and second (Pfizer) | CS | Bulbar symptoms | 1 (second) | Bulbar symptoms, diplopia | Spontaneous regression (first); regression 1 month after increasing steroids, one IVIG and RTX cycle (second) | MM | MM |
| F, 73 | AChR | IIIB | 7 | No/thyroiditis | 2 | Second (Pfizer) | CS, IVIG every 6 months | Four limbs fatigability | 0 | – | Spontaneous regression after 2 months | U | U |
| F, 83 | AChR | I | 6 | No/no | 3 | Third (Pfizer) | None | Diplopia | 0 | – | Regression 3 weeks after increasing Mestinon | MM | MM |
| F, 68 | AChR | IVB | 1 | Yes/thyroiditis | 3 | Third (Pfizer) | CS, AZA | Generalized weakness | 0 | – | Spontaneous regression after 4 days | MM | MM |
| F, 32 | MuSK | IIIB | 2 | No/no | 3 | Third (Pfizer) | CS, AZA | Dysphagia, facial muscles weakness | 0 | – | Spontaneous regression after 7 days | I | I |
| F, 63 | MuSK | IIB | 2 | No/no | 3 | Third (Pfizer) | CS | Ptosis and dysarthria | 0 | – | Spontaneous regression | MM | MM |
Abbreviations: AChR, acetylcholine receptor; AZA, azathioprine; CS, corticosteroids; CyA, cyclosporine A; F, female; FU, follow‐up; I, improved; IVIG, intravenous immunoglobulin; M, male; Max, maximum; MG, myasthenia gravis; MGFA, Myasthenia Gravis Foundation of America; MM, minimal manifestations; MuSK, muscle‐specific tyrosine kinase; PIS, postintervention status; RTX, rituximab; U, unimproved.