Clinical data of four patients with generalised gravis and SARS-CoV-2
Patient | 1 | 2 | 3 | 4 |
Disease duration | 6 years | 4 years | 2 years | 3 years |
MGFA classification | IIa | IIIb | IIa | V |
Thymectomy | Yes | Yes | No | Yes |
AB status | Anti-ACh-Rab | Anti-ACh-Rab | Negative | Anti-ACh-Rab |
Main symptoms prior to admission | Ocular, bulbar, lower limb weakness. | Respiratory muscles, limb weakness. | Unilateral ptosis, double vision. | Ocular (double vision). |
Comorbidities | M 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 treatment | AZA 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 change | AZA stopped during COVID-19; IVIG 5 days. | None. | None. | Pyridostigmine increased to 360 mg/day. |
COVID-19 disease course | Anosmia 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.