Myasthenia gravis amidst COVID-19

Purpose: The aim is to review immunological triggers as well as beneficial treatment regimens and their considerations in managing Myasthenia Gravis patients with varying severity of COVID-19 Methods: A systematic review was performed on 63 articles through an extensive search of PubMed, Science Direct, Google scholar, JAMA, and Scopus databases from the onset of COVID-19 to date using keywords, 'COVID-19,' 'Myasthenia Gravis,' 'Neuromuscular disease,' 'Immunosuppressants,' and 'Immunomodulators ' We excluded other neuromuscular disorders and included 18 articles of COVID-19 patients with Myasthenia Gravis No exclusions were made for age, sex, or geographical regions Results: During this COVID-19 pandemic, we need to be watchful for neuromuscular complications that may be directly or indirectly related to coronavirus infection Coronavirus, through molecular mimicry, forms autoantibodies against the neuromuscular junction that might trigger immune-mediated disorders such as Myasthenia Gravis (MG) MG patients on immunosuppressive or immunomodulatory therapy are predisposed to COVID- 19, manifesting severe complications Steroids have varied effects on COVID-19 patients depending on their stage of infection, not effective in earlier infection but beneficial in ARDS by inhibiting chemokine production IL-6 is an inflammatory marker found in COVID-19 and MG patients, which can be associated with a higher mortality rate Experimental therapies for COVID-19, such as combined use of azithromycin and hydroxychloroquine, may trigger a myasthenic exacerbation or crisis Hydroxychloroquine is known to result in potential neuromuscular side effects Diaphragm hemiparesis was possibly induced secondary to the myasthenic crisis in the setting of a viral illness and azithromycin's recent use Conclusions: Routine treatment for MG should be tailored depending on the COVID-19 severity Steroids and immunomodulators should be used with caution in MG patients However, limited data exist on how COVID-19 affects people with Myasthenia Gravis