COVID-19 in patients with myasthenia gravis

Muscle Nerve. 2020 Aug;62(2):254-258. doi: 10.1002/mus.26918. Epub 2020 May 22.

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) has rapidly become a global pandemic, but little is known about its potential impact on patients with myasthenia gravis (MG).

Methods: We studied the clinical course of COVID-19 in five hospitalized patients with autoimmune MG (four with acetylcholine receptor antibodies, one with muscle-specific tyrosine kinase antibodies) between April 1, 2020-April 30-2020.

Results: Two patients required intubation for hypoxemic respiratory failure, whereas one required significant supplemental oxygen. One patient with previously stable MG had myasthenic exacerbation. One patient treated with tocilizumab for COVID-19 was successfully extubated. Two patients were treated for MG with intravenous immunoglobulin without thromboembolic complications.

Discussion: Our findings suggest that the clinical course and outcomes in patients with MG and COVID-19 are highly variable. Further large studies are needed to define best practices and determinants of outcomes in this unique population.

Keywords: COVID-19; immunosuppression; myasthenia gravis; neuroimmunology; neuromuscular disorders.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged, 80 and over
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Betacoronavirus
  • COVID-19
  • COVID-19 Drug Treatment
  • Coronavirus Infections / complications
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / therapy*
  • Disease Progression
  • Female
  • Humans
  • Hypoxia / etiology
  • Hypoxia / therapy*
  • Immunoglobulins, Intravenous / therapeutic use*
  • Immunologic Factors / therapeutic use*
  • Immunosuppressive Agents / therapeutic use
  • Intubation, Intratracheal
  • Male
  • Middle Aged
  • Myasthenia Gravis / complications
  • Myasthenia Gravis / immunology
  • Myasthenia Gravis / therapy*
  • Oxygen Inhalation Therapy
  • Pandemics
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / therapy*
  • Receptor Protein-Tyrosine Kinases / immunology
  • Receptors, Cholinergic / immunology
  • Respiration, Artificial
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / therapy*
  • SARS-CoV-2

Substances

  • Antibodies, Monoclonal, Humanized
  • Immunoglobulins, Intravenous
  • Immunologic Factors
  • Immunosuppressive Agents
  • Receptors, Cholinergic
  • MUSK protein, human
  • Receptor Protein-Tyrosine Kinases
  • tocilizumab