COVID-19 PNEUMONIA COMPLICATED BY EXACERBATION OF NEW DIAGNOSIS OF MYASTHENIA GRAVIS

ABSTRACT

SESSION TITLE COVID-19 Case Report Posters 1 SESSION TYPE Case Report Posters PRESENTED ON 10/17/2022 1215 pm - 0115 pm INTRODUCTION: COVID-19 infection with concurrent myasthenia gravis (MG) presents a unique diagnostic challenge for the clinician. We report the case of a patient presenting with respiratory failure secondary to COVID-19 Pneumonia and being diagnosed with MG. CASE PRESENTATION Patient is a 72-year-old male without any significant medical history presented with progressively worsening shortness of breath, associated dysphagia and fatigue for 1-week duration. Laboratory data and imaging findings were suggestive of COVID-19 pneumonia. Patient's respiratory status deteriorated requiring mechanical ventilation. His oxygenation improved with steroid and anti-viral therapy. However, he was unable to be liberated from the ventilator secondary to neuromuscular weakness. Further work up confirmed MG. Patient was treated with high-dose steroids, pyridostigmine and intravenous immunoglobulin therapy. Patient was unable to be extubated and required a tracheostomy placement. DISCUSSION: Observational studies have suggested the rate of MG exacerbation to be 10-15% in COVID-19 infection. Mortality was found to be significantly higher in these patients compared to patients without MG. Several case reports have also shown exacerbation of previously asymptomatic MG with COVID-19 infection. Studies have indicated underlying MG to be an independent prognostic risk factor in COVID-19 infection. Treatment involves achieving symptomatic improvement with use of pyridostigmine, corticosteroids and long-term steroid sparing agents, in addition to administering usual treatment for COVID-19 infection. CONCLUSIONS: Our patient presents as a case of COVID 19 infection complicated with a possibly induced or previously undiagnosed case of MG complicating the clinical course. During evaluation of patients with respiratory failure secondary to COVID-19 infection, history focused on symptoms that may indicate underlying neuromuscular diseases should be obtained for early diagnosis and proper management. Given the high co-existence, it is important for clinicians to be aware of the association and treatment strategies in such patients. Reference #1 Galassi G, Marchioni A. Myasthenia gravis at the crossroad of COVID-19 focus on immunological and respiratory interplay. Acta Neurol Belg. 2021;121(3)633-642. doi10.1007/s13760-021-01612-6 Reference #2 Sriwastava S, Tandon M, Kataria S, Daimee M, Sultan S. New onset of ocular myasthenia gravis in a patient with COVID-19 a novel case report and literature review. J Neurol. 2021;268(8)2690-2696. doi10.1007/s00415-020-10263-1 Reference #3 Rodrigues CL, de Freitas HC, Lima PRO, et al. Myasthenia gravis exacerbation and myasthenic crisis associated with COVID-19 case series and literature review. Neurol Sci. 2022;43(4)2271-2276. doi10.1007/s10072-021-05823-w DISCLOSURES No relevant relationships by Asad Chohan No relevant relationships by Saiara Choudhury No relevant relationships by Rahul Dadhwal No relevant relationships by Rene Franco No relevant relationships by Ahsan Syed No relevant relationships by Pahnwat Taweesedt No relevant relationships by Abhay Vakil