Characteristics and Outcomes of Myasthenia Gravis Patients with COVID-19 – A Case Series (4807)

Objective: To investigate the effect of SARS-CoV-2 infection on patients with myasthenia gravis. Background: Myasthenic crisis is most commonly precipitated by infection and carries a mortality rate of about 4%. In patients with respiratory failure secondary to infection with the SARS-CoV-2, the mortality rate is estimated to be between 10–24%. The effect that COVID-19 has on patients with myasthenia gravis and the characteristics that affect outcome require further investigation. Design/Methods: Retrospective analysis of seven patients with Myasthenia Gravis infected with SARS-CoV-2. Results: Of the seven patients with myasthenia gravis, baseline neurologic exam, comorbidities (diabetes, age, BMI) and medication regimen prior to infection with SARS-CoV-2 did not clearly appear to affect the probability of requiring admission or mortality. Five of the seven patients required hospitalization, with two eventually expiring. Both patients who expired had the longest disease duration of the group (mean = 9 years), with respiratory failure as the cause of clinical decompensation. Higher inflammatory markers (i.e. ESR, CRP, D-dimer) were found on serologic studies of those two patients, with marked increases in ferritin and D-dimer levels. Lower absolute lymphocyte count appears to be associated with worse clinical outcome. Of note, two of the five hospitalized patients received a dose of a monoclonal antibody against interleukin-6 (i.e. tocilizumab) and had marked improvement in their clinical course, ultimately discharged at their baseline neurologic status. Conclusions: These patients appear to share some of the typical risk factors for poor outcomes in patients with myasthenic crises without SARS-CoV-2 infection. The management of immunosuppression in this patient population is challenging, but a benefit of immunosuppression is suggested. Further larger scale investigations to delineate specific guidelines and establish factors that affect clinical outcomes in this specific patient population is warranted. Disclosure: Dr. Granger has nothing to disclose. Dr. Kwon has nothing to disclose. Dr. Zakin has nothing to disclose.