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01-09-2021 | Myasthenia Gravis | Short Commentary

Complement inhibition initiated recovery of a severe myasthenic crisis with COVID-19

Authors: Ulrich Hofstadt-van Oy, Slobodan Stankovic, Corinna Kelbel, Daniel Oswald, Simon Larrosa-Lombardi, Thomas Barchfeld, Ulrich Cleff

Published in: Journal of Neurology | Issue 9/2021

Abstract

We report on a patient with refractory Myasthenia gravis with acetylcholine receptor antibodies with two prior myasthenic crises suffering from COVID-19 with rapid evolving weakness and respiratory failure. Respiratory failure developed and prolonged mechanical ventilation was necessary. After plasmapheresis, residual, severe generalized and bulbar weakness persisted. Complement inhibition with eculizumab was, therefore, introduced and lead to rapid recovery. In refractory myasthenic crisis individualised therapies could be successful.

Gilhus NE (2016) Myasthenia gravis. N Engl J Med 375:2570–2581CrossRef

Chaudhuri A, Behan PO (2009) Myasthenic crisis. QJM 2009(102):97–107

Neumann B, Angstwurm K, Mergenthaler P et al (2020) Myasthenic crisis demanding mechanical ventilation. A multicenter analysis of 250 cases. Neurology. https://doi.org/10.1212/WNL.0000000000008688CrossRefPubMed

Melzer N, Ruck T, Fuhr P et al (2016) Clinical features, pathogenesis, and treatment of myasthenia gravis: a supplement to the Guidelines of the German Neurological Society. J Neurol 263:1473–1494. https://doi.org/10.1007/s00415-016-8045-zCrossRefPubMedPubMedCentral

Muppidi S, Guptil JT, Jacob S et al (2020) COVID-19-associated risks and effects in Myasthenia gravis (CARE-MG). Lancet Neurol 19:970–971CrossRef

Jaretzki A, Barohn RJ, Ernstoff RM, Kaminski HJ et al (2000) Myasthenia gravis: recommendations for clinical research standards. Neurology 55:16–23CrossRef

Burns TM, Grouse CK, Wolfe GI et al (2011) The MG-QOL15 for following the health-related quality of life of patients with myasthenia gravis. Muscle Nerve 43:14–18CrossRef

Wolfe GI, Herbelin L, Nations SP, et al. (1999) Myasthenia gravis activities of daily living profile. Neurology. 52: 1487–1487.

Mantegazza R, Antozzi C (2018) When myasthenia gravis is deemed refractory: clinical signposts and treatment strategies. Ther Adv Neurol Disord 11:1756285617749134CrossRef

10.

International MG/COVID-19 Working Group, Jacob S, Muppidi S, Guidon A, et al. (2020) Guidance for the management of myasthenia gravis (MG) and Lambert–Eaton myasthenic syndrome (LEMS) during the COVID-19 pandemic. J Neurol Sci. 15: 412:116803. https://doi.org/10.1016/j.jns.2020.116803

11.

Yang X, Niu L, Yang C et al (2019) Clinical features of laryngeal myasthenia gravis: a case series. Am J Otolaryng 40:292–296CrossRef

12.

RECOVERY Collaborative Group (2020) Dexamethasone in hospitalized patients with Covid-19—preliminary report. N Engl J Med. https://doi.org/10.1056/NEJMoa2021436CrossRef

13.

Risitano AM, Mastellos DC, Huber-Lang M et al (2020) Complement as a target in COVID-19? Nat Rev Immunol 20:343–344. https://doi.org/10.1038/s41577-020-0320-7CrossRefPubMed

Title: Complement inhibition initiated recovery of a severe myasthenic crisis with COVID-19
Authors: Ulrich Hofstadt-van Oy
Slobodan Stankovic
Corinna Kelbel
Daniel Oswald
Simon Larrosa-Lombardi
Thomas Barchfeld
Ulrich Cleff
Publication date: 01-09-2021
Publisher: Springer Berlin Heidelberg
Keywords: Myasthenia Gravis
Azathioprine
COVID-19
Tracheostomy
Azathioprine
Published in: Journal of Neurology / Issue 9/2021
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-021-10428-6

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Complement inhibition initiated recovery of a severe myasthenic crisis with COVID-19

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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