Abstract：
BACKGROUND: Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction that can be exacerbated by many viral infections, including COVID-19. The management of MG exacerbations is challenging in this scenario. We report 8 cases of MG exacerbation or myasthenic crisis associated with COVID-19 and discuss prognosis and treatment based on a literature review.
RESULTS: Most patients were female (7/8), with an average age of 47.1 years. Treatment was immunoglobulin (IVIG) in 3 patients, plasma exchange (PLEX) in 2 patients, and adjustment of baseline drugs in 3. In-hospital mortality was 25% and 37.5% in 2-month follow-up.
CONCLUSIONS: This is the largest case series of MG exacerbation or myasthenic crisis due to COVID-19 to this date. Mortality was considerably higher than in myasthenic crisis of other etiologies. Previous treatment for MG or acute exacerbation treatment did not seem to interfere with prognosis, although sample size was too small to draw definitive conclusions. Further studies are needed to understand the safety and effectiveness of interventions in this setting, particularly of PLEX, IVIG, rituximab, and tocilizumab.
RESULTS: Most patients were female (7/8), with an average age of 47.1 years. Treatment was immunoglobulin (IVIG) in 3 patients, plasma exchange (PLEX) in 2 patients, and adjustment of baseline drugs in 3. In-hospital mortality was 25% and 37.5% in 2-month follow-up.
CONCLUSIONS: This is the largest case series of MG exacerbation or myasthenic crisis due to COVID-19 to this date. Mortality was considerably higher than in myasthenic crisis of other etiologies. Previous treatment for MG or acute exacerbation treatment did not seem to interfere with prognosis, although sample size was too small to draw definitive conclusions. Further studies are needed to understand the safety and effectiveness of interventions in this setting, particularly of PLEX, IVIG, rituximab, and tocilizumab.
摘要：
背景：重症肌无力（MG）是一种神经肌肉接头的自身免疫性疾病，可因许多病毒感染而加剧，包括COVID-19。在这种情况下，MG恶化的管理具有挑战性。我们报告了8例MG加重或与COVID-19相关的肌无力危象，并根据文献复习讨论了预后和治疗。
结果：大多数患者为女性（7/8），平均年龄为47.1岁。3例患者采用免疫球蛋白（IVIG）治疗，2例患者血浆置换（PLEX），和调整基线药物3。在2个月的随访中，住院死亡率分别为25％和37.5％。
结论：这是迄今为止因COVID-19引起的MG加重或肌无力危象的最大病例系列。死亡率远高于其他病因的肌无力危机。先前对MG的治疗或急性加重治疗似乎不会干扰预后，尽管样本量太小，无法得出明确的结论。需要进一步的研究来了解这种情况下干预措施的安全性和有效性。尤其是PLEX,IVIG,利妥昔单抗,和托珠单抗。
结果：大多数患者为女性（7/8），平均年龄为47.1岁。3例患者采用免疫球蛋白（IVIG）治疗，2例患者血浆置换（PLEX），和调整基线药物3。在2个月的随访中，住院死亡率分别为25％和37.5％。
结论：这是迄今为止因COVID-19引起的MG加重或肌无力危象的最大病例系列。死亡率远高于其他病因的肌无力危机。先前对MG的治疗或急性加重治疗似乎不会干扰预后，尽管样本量太小，无法得出明确的结论。需要进一步的研究来了解这种情况下干预措施的安全性和有效性。尤其是PLEX,IVIG,利妥昔单抗,和托珠单抗。
