SARS-CoV-2 in pre-existing autoimmune myasthenia gravis: An institutional experience

Abstract

The impact of SARS-CoV-2 on pre-existing chronic neuromuscular junction disorders like myasthenia gravis (MG) is not known. We report three patients with pre-existing acetylcholine receptor autoantibody-positive myasthenia gravis who were infected with SARS-CoV-2. We observed the clinical course of these patients during hospitalization, none of the three patients had an exacerbation of peripheral myasthenia syndromes like ptosis, extra-ocular muscle weakness, bulbar or limb weakness during hospitalization. Therapy for MG was not altered during hospitalization for any of the patients. While two of the patients had a favorable outcome, one succumbed to the complications of SARS-CoV-2. Our findings suggest that the clinical course of MG remains unaffected during course, however outcome is variable depending on severity of SARS-CoV-2. Further large observations are needed to define best management and treatment principals and determinants of outcomes in this unique patient population of co-occurrence of SARS-CoV-2 and myasthenia gravis.

Keywords

• covid-19
• myasthenia gravis
• neuroimmunology
• neuromuscular disorders
• immunosuppression