title: West nile virus infection and myasthenia gravis.
abstract: BACKGROUND
  Viruses are commonly cited as triggers for autoimmune disease. It is unclear if West Nile virus (WNV) initiates autoimmunity.
  
  
  METHODS
  We describe 6 cases of myasthenia gravis (MG) that developed several months after WNV infection. All patients had serologically confirmed WNV neuroinvasive disease. None had evidence of MG before WNV.
  
  
  RESULTS
  All patients had stable neurological deficits when they developed new symptoms of MG 3 to 7 months after WNV infection. However, residual deficits from WNV confounded or delayed MG diagnosis. All patients had elevated acetylcholine receptor (AChR) antibodies, and 1 had thymoma. Treatment varied, but 4 patients required acetylcholinesterase inhibitors, multiple immunosuppressive drugs, and intravenous immune globulin or plasmapheresis for recurrent MG crises.
  
  
  CONCLUSIONS
  The pathogenic mechanism of MG following WNV remains uncertain. We hypothesize that WNV-triggered autoimmunity breaks immunological self-tolerance to initiate MG, possibly through molecular mimicry between virus antigens and AChR subunits or other autoimmune mechanisms.
authors.affiliation: Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson, Suite 2, Jackson, Mississippi, 39216, USA.
authors.forename: A Arturo
authors.initials: AA
authors.lastname: Leis
authors.forename: Gabriella
authors.initials: G
authors.lastname: Szatmary
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ross
authors.forename: Dobrivoje S
authors.initials: DS
authors.lastname: Stokic
mesh_terms: D000368:Aged; D000906:Antibodies / Q000097:blood; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000276:immunology* / Q000628:therapy / Q000821:virology*; D010956:Plasmapheresis; D011950:Receptors, Cholinergic / Q000276:immunology; D012189:Retrospective Studies; D017634:Self Tolerance / Q000276:immunology; D014901:West Nile Fever / Q000150:complications* / Q000276:immunology* / Q000628:therapy; D014902:West Nile virus
chemical_list: D000906:Antibodies; D002800:Cholinesterase Inhibitors; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D011950:Receptors, Cholinergic
keywords: West Nile virus; autoimmunity; molecular mimicry; myasthenia gravis; neuromuscular junction; poliomyelitis