Table 1

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

Disease duration6 years4 years2 years3 years
MGFA classificationIIaIIIbIIaV
AB statusAnti-ACh-RabAnti-ACh-RabNegativeAnti-ACh-Rab
Main symptoms prior to admissionOcular, bulbar, lower limb weakness.Respiratory muscles, limb weakness.Unilateral ptosis, double vision.Ocular (double vision).
ComorbiditiesM Basedow (resolved in 2015).Behçet‘s disease, chronic migraine, hypogonadotrope hypogonadism, hypothyroidism, obesity, thymoma.Arterial hypertension.Obesity, left phrenic nerve damage, sleep apnoea.
MG baseline treatmentAZA 50 mg/day, pyridostigmine 60 mg 5–6×/day.Pyridostigmine 60 mg 4–5×/day, prednisone 25 mg/day, subcutaneous immunoglobulins 12 g every 4 days.Pyridostigmine 3×30 mg/day.Pyridostigmine 60 mg 3×/day, rituximab 1 g every 6 months.
MG treatment changeAZA stopped during COVID-19; IVIG 5 days.None.None.Pyridostigmine increased to 360 mg/day.
COVID-19 disease courseAnosmia after 4 weeks.Fluctuating headaches and respiratory symptoms over 6 weeks.Fully recovered after around 3 weeks.Mechanical ventilation >14 days, tracheostoma for 9 weeks.
  • AZA, azathioprine; IVIG, intravenous immunoglobulin; MG, myasthenia gravis; MGFA, Myasthenia Gravis Foundation of America; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.