Article Text

Download PDFPDF
Management of patients with generalised myasthenia gravis and COVID-19: four case reports
  1. Annemarie Hübers1,
  2. Agustina M Lascano2,
  3. Patrice H Lalive3
  1. 1 Department of Clinical Neurosciences, University Hospitals Geneva, Geneve, Switzerland
  2. 2 Division of Neurology, University Hospitals of Geneva, Geneva, Switzerland
  3. 3 Department of Clinical Neurosciences, Division of Neurology, Unit of Neuroimmunology and Multiple Sclerosis, University Hospitals Geneva, Geneva, Switzerland
  1. Correspondence to Dr Annemarie Hübers, University Hospitals Geneva Department of Clinical Neurosciences, Geneve 1211, Switzerland; annemarie.hubers{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


Myasthenia gravis (MG) is an autoimmune disease characterised by fluctuating muscle weakness with potentially life-threatening symptoms due to insufficiency of respiratory muscles. Treatment usually includes immunosuppressive drugs and cholinesterase inhibitors. COVID-19 is an infection caused by the newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), defined as a pandemic by the World Health Organisation (WHO).

Although guidelines for the management of patients with MG during the COVID-19 pandemic have been published,1 these recommendations are based on theoretical considerations only, as no clinical data are available.

We describe four patients with generalised MG affected by COVID-19 (around 10% of patients in our cohort). Clinical data are summarised in table 1.

View this table:
Table 1

Clinical data of four patients with generalised gravis and SARS-CoV-2

Case 1

A 36-year-old female patient, class IIa according to the Myasthenia Gravis Foundation of America (MGFA) score (166 cm, 67 kg), presented to Geneva University Hospital on 15 March 2020 with myalgia, coughing and fever >38°C on the same day. She was taking azathioprine (AZA) 50 mg, reintroduced at the end of January 2020, and pyridostigmine 60 mg five to six times per day. The last deterioration of MG had occurred in January 2020 requiring intravenous immunoglobulin (IVIG) treatment (Myasthenia Muscle Score 65/100). COVID-19 real-time PCR (RT-PCR) revealed a positive result. Chest X-ray showed no pulmonary infiltration and peak flow was at 400 mL (82%). The Myasthenia Muscle …

View Full Text


  • Contributors AH and AML wrote the manuscript. AH and AML examined the patients and collected the clinical data. PHL reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication On hand.

  • Provenance and peer review Not commissioned; externally peer reviewed.