COVID-19 in patients with myasthenia gravis

Authors: Anand, P, Slama, MCC, Kaku, M, Ong, C, Cervantes-Arslanian, AM, Zhou, L. David, WS, and Guidon, AC.

Publication: Muscle Nerve; May 2020

Affiliations: Department of Neurology, Boston University Medical Center, Boston, Massachusetts ; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts ; Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts.

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.