Key result
Rituximab improves cardiac function in a patient with myasthenic crisis presenting as MINOCA.
This case highlights MINOCA as a potential presentation of myasthenic crisis and demonstrates successful treatment with rituximab leading to cardiac recovery after failure of standard therapies.
Hypothesis-generating for rituximab in refractory myasthenic MINOCA; prospective trials needed before clinical adoption.
We present a case of a patient with undiagnosed myasthenia gravis presenting in myasthenic crisis. In this case, the patient presented primarily with myocardial infarction with nonobstructive coronary arteries and respiratory failure and was later diagnosed to be in myasthenic crisis. The myasthenic crisis was treated with intravenous immunoglobulin (IVIg) and corticosteroids. Given the inadequate response to IVIg and glucocorticoids, the patient was subsequently administered an anti-CD20 monoclonal antibody in the form of rituximab. The patient responded well to rituximab, and her cardiac function subsequently improved.
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Ginwala et al. (2026) studied this question. Rituximab treatment improved cardiac function in a patient with myasthenic crisis presenting as myocardial infarction with nonobstructive coronary arteries.
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