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Exacerbation of myasthenia gravis after amoxicillin therapy: a case series

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Abstract

Introduction

Myasthenia gravis (MG) can be aggravated by several classes of drugs, including antibiotics. Penicillins are considered safe drugs for the management of infectious disease in patients with MG. However, a few cases of MG exacerbations after penicillin treatment have been reported in literature.

Case reports

We report six patients with MG developing acute worsening of symptoms after amoxicillin or amoxicillin/clavulanate treatment. In most of the cases, symptoms started in a few days after antibiotic administration. In all cases, we observed a worsening of the Myasthenia Gravis Foundation of America (MGFA) clinical classification. Most patients required a therapeutic intervention with dosage increase of the previous therapy or the introduction of new drugs for MG. All patients had a full recovery to baseline neurological conditions within 1–2 months.

Conclusions

We concluded that patients receiving amoxicillin should be closely monitored for possible acute relapse.

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Acknowledgments

We are thankful to the patients for their participation in the study. We also are thankful to "Fondazione Il Bene Onlus" and to "Associazione Miastenia Insieme".

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Authors and Affiliations

  1. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

    Veria Vacchiano & Rocco Liguori

  2. Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy

    Piergiorgio Solli

  3. Neurology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

    Ilaria Bartolomei & Fabrizio Salvi

  4. Department of General and Thoracic Surgery, University Hospital of Chieti, Chieti, Italy

    Giulia Lai

  5. UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

    Rocco Liguori

Authors
  1. Veria Vacchiano
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  2. Piergiorgio Solli
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  3. Ilaria Bartolomei
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  4. Giulia Lai
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  5. Rocco Liguori
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  6. Fabrizio Salvi
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Corresponding author

Correspondence to Veria Vacchiano.

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Conflict of interest

V. Vacchiano, P. Solli, I. Bartolomei, G. Lai, and F. Salvi report no disclosures.

R. Liguori reports personal fees from Biogen, Sanofi Genzyme, Argon Healthcare s.r.l., Amicus Therapeutics s.r.l., and Alfasigma for advisory board consultancy and lecture fees from Dynamicom Education, SIMG Service, Adnkronos Salute Unipersonale s.r.l., and DOC Congress s.r.l. outside the submitted work.

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Informed consent was obtained from all individual participants included in the study.

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Vacchiano, V., Solli, P., Bartolomei, I. et al. Exacerbation of myasthenia gravis after amoxicillin therapy: a case series. Neurol Sci 41, 2255–2257 (2020). https://doi.org/10.1007/s10072-020-04387-5

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  • DOI: https://doi.org/10.1007/s10072-020-04387-5

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