Case series of myasthenia gravis patients with COVID-19 infection

Objective: To report the clinical course and outcome of six patients with known diagnosis of Myasthenia Gravis (MG) who developed COVID-19 infection. Background: It is hypothesized that patients with MG with COVID-19 infection may have a worse outcome given their known respiratory muscle weakness and immuno-compromised condition. There is scarce data available about their prognosis and outcomes. Design/Methods: Electronic medical records of patients with MG who developed COVID-19 were reviewed. Results: Charts of six patients with known MG who were diagnosed with COVID-19 were reviewed. Five of the patients were females, age range 36-80 years, with 4 being Caucasian. 50% were Acetylcholine receptor antibody positive. Duration for MG was between 1-5 years for most, except one patient who had the diagnosis for > 20 years. Majority of the patients presented with shortness of breath, cough, fever and myalgia except for one patient who presented with chest pain. Three were diagnosed with COVID-19 pneumonia, and 1 with subsegmental PE. Most patients were treated with IV solumedrol, plaquenil, broad spectrum antibiotics and vitamins. One patient was treated with tocilizumab. All patients were continued on their home regimen of MG treatment, with prednisone and mestinon. Imuran was also continued in one patient and Intravenous Immunoglobulin (IVIG) for another. One patient suffered an MG exacerbation and received IVIG for 5 days. Two patients were intubated for respiratory failure and suffered from other systemic complications related to COVID-19. They also had other medical co-morbidities compared to others. The length of stay ranged from 1-33 days. All patients recovered and were discharged home except for two who were discharged to rehabilitation facility. Conclusions: The prognosis of patients with MG and COVID-19 infection was favorable based on the results of these patients. The baseline immuno-suppressive therapy was not associated with worse outcomes and hence maintenance doses should be continued.