Myasthenia Gravis following Coxsackie Encephalitis

Background: Myasthenia gravis (MG) is a common autoimmune neuromuscular disorder. There is scarce literature on preceding infection leading to MG. We present a case of MG developed after coxsackie virus encephalitis. Case Description Case description: A 62 year-old man who initially presented with acute alteration of mental status. Cerebrospinal fluid (CSF) analysis revealed a mild pleocytosis (42 white cells/uL) with lymphocytic predominance. CSF coxsackie virus A09, B2, and B5 antibodies were high (1:100, 1:32, 1:64 respectively). He was diagnosed with coxsackie encephalitis and recovered in two months. Five months later, he presented with a 3-week history of diplopia, ptosis, dysphagia, and hoarseness. Acetylcholine receptor binding, blocking, and modulating antibodies were all elevated. Seropositive MG responded well to a combination of oral prednisone and pyridostigmine. Conclusion: MG developed several months after coxsackie encephalitis. Given the temporal relationship, MG is possibly due to coxsackie virus triggering host autoimmunity