COVID-19 in patients with myasthenia gravis

ABSTRACT

Various infections can frequently lead to the exacerbation of myasthenia gravis (MG). COVID-19 infection characterized by lung impairment with respiration failure, massive infl ammatory reaction and high mortality may lead to worsening of many neuromuscular disorders including MG. Published series of patients with MG and COVID-19 are considerably variable and dill er in disease severity and selected therapeutic approach. In our group of 11 MG patients, substantial worsening was present in 3 patients, and in 4 there was a mild worsening of clinical myasthenic symptoms. In 3 patients, we used high doses of methylprednisolone intravenously, in 2 patients, the oral doses of prednisone were increased to 40 mg/ 60 mg a day, 1 patient was treated with intravenous immunoglobulin (2 g/ kg), and 1 was treated with remdesivir. An 88-year-old woman was dia gnose d with MG after COVID-19 infection. A 77-year-old man died after 6 days of mechanical ventilation. COVID-19 infection leads to an exacerbation of clinical symptoms in a large proportion of MG patients with ventilation disorder due to increased muscle fatigue and inflammatory changes in the lung parenchyma.