Transient Neonatal Myasthenia Gravis Born to a Mother with Asymptomatic MG: A Case Report

Abstract

Myasthenia gravis (MG) is an autoimmune disease which can impact pregnancy. We describe a transient neonatal myasthenia gravis (TNMG) born to an asymptomatic mother aged 26. The newborn presented cyanosis and generalized muscular weakness quickly after birth. Nasal continuous positive airway pressure (nCPAP) ventilation was performed immediately. On day 3, detailed family history showed that the neonate’s 50-year-old maternal grandmother was diagnosed as ocular MG at the age of 40. Ryanodine receptor calcium release channel antibody (RyR-Ab) and acetylcholine receptor antibody (AChR-Ab) tested on day 5 were positive. However, neostigmine tests were negative for the neonate. Intravenous immunoglobulin (IVIG) and oral pyridostigmine were administered. The infant was weaned from the ventilator on day 7. On day 10, the neonate’s asymptomatic mother was confirmed to have positive AChR-Ab either. The neonate regained the capability of bottle feeding on day 17 and discharged on day 26. Asymptomatic pregnant women with MG family history can also deliver infants who develop TNMG. Testing AChR antibodies in pregnant women with a family history of MG should be necessary as TNMG was a life-threatening disease. With timely diagnosis and accurate treatment, TNMG can be effectively relieved.

Keywords:

• transient neonatal myasthenia gravis
• asymptomatic MG
• IVIG
• pyridostigmine

Data Available Statement

All the necessary data that help the results of the case report are incorporated in the manuscript.

Ethical Publication Statement

We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Informed consent was obtained from the neonate’s parents for the publication of this case report. The study has received ethical approval from Ethics Committee of Shenzhen Third People’s Hospital (no. 2022-083-02).

Acknowledgment

We would like to thank postdoctoral research fellow Mengyun Cai from the Institute of Translational Medicine of the First Poeple’s Hospital of Foshan for guiding us in drawing figures and tables. We are grateful to the patient and her family for consenting to this study.

Author Contributions

All authors made a significant contribution to the case reported, whether that is in the conception, study design, acquisition of data, execution, analysis and interpretation; took part in drafting, revising and critically reviewing the article; all authors have agreed on the journal to which the article has been submitted.

Disclosure

None of the authors has any conflict of interest to disclose for this work.

Additional information

Funding

This work is supported by the Foundation (no. 22240G1034) of Shenzhen Third People’s Hospital.