Management of myasthenia in COVID-19 patients

With interest we read the article by Aksoy et al. about a 46 years old female with myasthenia gravis (MG) due to antibodies against the acetyl-choline receptor (AchR) being treated with 120mg pyridostigmine per day in whom MG exacerbated in the course of an infection with SARS-CoV-2 (COVID-19) [1]. It was concluded that early immune-modulatory therapy may be more effective in terms of preventing permanent lung damage than standard first-line treatments in patients with MG [1]. We have the following comments and concerns.