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We extend our sincere appreciation for the valuable contribution of the authors of the Letter to the Editor to our article titled “Musculoskeletal manifestations of COVID‐19” [1]. The primary objective of this article was to comprehensively review the main imaging findings associated with SARS-CoV-2 infection in the musculoskeletal system, encompassing post-vaccination manifestations.
There are few reports in the literature discussing the correlation between SARS-CoV-2 infection, vaccination, and an increased risk of new-onset myasthenia gravis and myasthenic crisis [2, 3]. However, we have not identified literature reports detailing musculoskeletal system imaging studies in patients with post-COVID or post-vaccination myasthenia gravis. Our service operates in the metropolitan region of São Paulo, Brazil, covering an area with a population exceeding 20 million people, and thus far, we have not encountered any cases of musculoskeletal system imaging studies in patients with post-COVID/vaccination myasthenia gravis.
Peripheral nerve involvement, discussed in this article, is another complication that may be associated with COVID-19 infection. Despite being a potential complication of this viral infection, cranial nerve involvement [4, 5] has not been discussed in this article, as the authors believe that this topic is better suited for articles in neuroradiology/head and neck specialties. As the author of the letter indicated, sacral plexus neuritis is another important form of neural involvement, discussed in detail in our manuscript and illustrated with a case in Fig. 6 of this article [1].
We express our gratitude for your contribution in bringing to our attention the report of the first case of eosinophilic fasciitis described in the literature [6]. Notably, this case was published after our submission for publication in the journal on August 1, 2023. Also, we have not identified any cases in our institution.
COVID-19 infection and the rare post-vaccination complications are extensive subjects in the literature. We thank the authors for their contribution to this review, addressing an important topic that is continually evolving. With new articles published in the literature, this ongoing process enables a better understanding of imaging patterns across various manifestations of COVID‐19 and related vaccination for radiologists.
References
da Silva LNM, Filho AGO, Guimarães JB. Musculoskeletal manifestations of COVID-19. Skelet Radiol. 2023;1–14.
Tugasworo D, Kurnianto A, Retnaningsih, Andhitara Y, Ardhini R, Budiman J. The relationship between myasthenia gravis and COVID-19: a systematic review. Egypt J Neurol Psychiatr Neurosurg. 2022;58(1):83.
Hoshina Y, Sowers C, Baker V. Myasthenia gravis presenting after administration of the mRNA-1273 vaccine. Eur J Case Rep Intern Med. 2022;9(7):003439.
Doblan A, Kaplama ME, Ak S, Basmacı N, Tarini EZ, Göktaş ŞE, Güler S, Müderris T. Cranial nerve involvement in COVID-19. Am J Otolaryngol. 2021;42(5):102999.
Finsterer J, Scorza FA, Scorza C, Fiorini A. COVID-19 associated cranial nerve neuropathy: a systematic review. Bosn J Basic Med Sci. 2022;22(1):39–45.
Boussaa H, Kamoun M, Makhlouf Y, Abdelghani KB, Fazaa A, Laatar A. The first case of SARS-CoV-2 induced eosinophilic fasciitis. Mod Rheumatol Case Rep. 2023;30:rxad063.
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da Silva, L.N.M., Filho, A.G.O. & Guimarães, J.B. Authors’ response to the Letter to the Editor. Skeletal Radiol (2024). https://doi.org/10.1007/s00256-024-04608-4
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DOI: https://doi.org/10.1007/s00256-024-04608-4