ABSTRACT
Background: Covid 19 has been shown to cause neurological manifestations due to direct infection by the virus or by the body's innate and adaptive immune response to infection.1,4 Patients with underlying neurological conditions can also be impacted by Covid 19 due to the use of immunosuppressant therapy. It can be challenging to determine in the emergency setting if symptoms are due to a viral infection versus the underlying neurologic condition. Sometimes therapies are withheld due to this uncertainty. Studies done during the ongoing Covid 19 pandemic, have shown an increased risk of hospitalization and death in Covid 19 patients with myasthenia gravis (MG) compared to those without. 2,3 Not much is known about the safety and efficacy of monoclonal antibody treatments for Covid 19 in myasthenic patients. Discussion(s): A 32-year-old woman with acetylcholine receptor positive MG presented to the Emergency Department (ED) with a 2 day history of fever, chills and bilateral upper and lower extremity weakness. She reported a fall and gait impairment for one day. Her last IVIG administration was in 2017. She was on azathioprine, prednisone and pyridostigmine, and was fully vaccinated for Covid 19 per CDC recommendations. Her blood pressure was 142/80, pulse rate 108, temperature 100.1 F and respiratory rate 18/minute. Significant neurological findings included power 3/5 in bilateral elbow and knee extensors, with the rest of the muscle groups at power 5/5. Covid PCR test was positive. Basic Laboratory investigations and a Chest X ray were unremarkable, and pulmonary mechanics, revealed a NIF of -50. The patient received a monoclonal antibody cocktail for Covid 19 infusion in the ED. She reported improvement and was discharged home after 48 hours. She was seen in clinic a month later and reported no residual symptoms. Conclusion(s): Monoclonal antibody treatment administered soon after the onset of symptoms is safe and may prevent myasthenic crisis. Treatment for Covid 19 and variants should not be withheld uniformly in patients with neuromuscular junction disorders.