Netaniel Rein1, Nitzan Haham2, Efrat Orenbuch-Harroch3, Marc Romain4, Zohar Argov5, Adi Vaknin-Dembinsky6, Marc Gotkine7. 1. Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel. Electronic address: Netaniel.rein@mail.huji.ac.il. 2. Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel. Electronic address: Nitan.haham@mail.huji.ac.il. 3. Hadassah-Hebrew University Medical Center, Medical intensive care unit, Jerusalem, Israel. 4. Hadassah-Hebrew University Medical Center, Medical intensive care unit, Jerusalem, Israel. Electronic address: Marcro@hadassah.org.il. 5. Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel. Electronic address: zohara@ekmd.huji.ac.il. 6. Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel. 7. Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel. Electronic address: marc@gotkine.com.
Abstract
BACKGROUND: The COVID-19 pandemic presents two main concerns for patients with myasthenia gravis (MG); chronic immunosuppression may put them at greater risk, and some proposed treatments for COVID-19 could cause MG exacerbation. CASE DESCRIPTION: We present three patients with generalized seropositive MG who developed COVID-19. All patients had a favorable outcome, with only one patient experiencing exacerbation. In this case, exacerbation began before COVID-19; she required ICU admission, non-invasive ventilatory support, and received hydroxychloroquine, lopinavir and ritonavir which were well tolerated. One patient received IVIG in place of scheduled plasma exchange. CONCLUSION: Outcome was favorable in all cases despite immunosuppressive therapy, use of experimental COVID-19 medication and switching of plasma exchange for IVIG.
BACKGROUND: The COVID-19 pandemic presents two main concerns for patients with myasthenia gravis (MG); chronic immunosuppression may put them at greater risk, and some proposed treatments for COVID-19 could cause MG exacerbation. CASE DESCRIPTION: We present three patients with generalized seropositive MG who developed COVID-19. All patients had a favorable outcome, with only one patient experiencing exacerbation. In this case, exacerbation began before COVID-19; she required ICU admission, non-invasive ventilatory support, and received hydroxychloroquine, lopinavir and ritonavir which were well tolerated. One patient received IVIG in place of scheduled plasma exchange. CONCLUSION: Outcome was favorable in all cases despite immunosuppressive therapy, use of experimental COVID-19 medication and switching of plasma exchange for IVIG.