PMC9512128_01
Timeline of major events in the recent history of the case: SARS-CoV-2 vaccination, COVID-19 positive diagnosis, onset of class IIB myasthenia gravis followed by successfully treated myasthenic crisis.
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However, nine days after COVID-19 diagnosis he developed acute-onset diplopia, asymmetrical bilateral ptosis, dysphonia and dysphagia, with no reported diurnal variation and a progressive evolution during the following four days (Figure 1). As the patient refused prednisone intake at home, two months later, on the January 10th 2022, the patient returned to the emergency room due to a prior two weeks acute onset and a progressive course of an aggravated diplopia, bilateral ptosis, dysphagia for both liquids and solids and dyspnea (Figure 1).
Abnormal decrementing response at slow repetitive nerve stimulation of right Nasalis muscle.
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Slow repetitive nerve stimulation (RNS) of right nasalis muscle revealed an abnormal decrementing response between 17.3%-20.8% (Figure 2).