Department of Neurology, University of Missouri Health Care, Missouri.
Medicine (Baltimore). 2021 May 7;100(18):e25701. doi: 10.1097/MD.0000000000025701.
Myasthenia gravis (MG) patients are at increased risk of COVID-19 infection and its complications due to chronic immunosuppression. COVID-19 infection can also increase the risk of myasthenia exacerbation.
The patient presented with respiratory distress, fever and chills and was diagnosed with COVID-19 pneumonia. His past medical history includes seropositive generalized MG diagnosed in 2019, hypertension, atrial fibrillation and congestive heart failure with reduced ejection failure.
Refractory seropositive generalized MG having COVID-19 pneumonia and respiratory failure (needing mechanical ventilation) with sepsis.
Use of intravenous remdesivir and dexamethasone and patient's myasthenic exacerbation (due to COVID-19 and its complications) was successfully treated with plasmapheresis.
Patient was successfully weaned off ventilator to trach collar and was discharged to inpatient rehabiliation. He was followed up 1 month post hospital discharge and was on trach collar.
This case report illustrates early use of the combination therapy might be beneficial in refractory myasthenia gravis cases even with chronic immunosuppression and severe COVID-19 infection.
由于慢性免疫抑制，重症肌无力 (MG) 患者感染 COVID-19 及其并发症的风险增加。COVID-19 感染也会增加重症肌无力恶化的风险。
该患者出现呼吸窘迫、发热和寒战，并被诊断患有 COVID-19 肺炎。他既往有医学史，包括 2019 年确诊的血清阳性全身型 MG、高血压、心房颤动和射血分数降低的充血性心力衰竭。
COVID-19 肺炎伴呼吸衰竭（需要机械通气）和脓毒症的难治性血清阳性全身型 MG。
使用静脉注射瑞德西韦和地塞米松，患者的重症肌无力恶化（由于 COVID-19 及其并发症）经血浆置换成功治疗。
患者成功地从呼吸机转为气管切开套管，并出院至住院康复。他在出院后 1 个月进行了随访，仍在使用气管切开套管。
本病例报告表明，即使存在慢性免疫抑制和严重 COVID-19 感染，早期使用联合治疗可能对难治性重症肌无力病例有益。
