Acute exacerbations of myasthenia gravis in COVID-19 infection: A case report on the role of plasmapheresis in preventing intubation

Introduction: Myasthenia gravis (MG) is an autoimmune condition characterized by the production of autoantibodies against acetylcholine receptors, leading to neuromuscular weakness and potentially life-threatening myasthenic crises. The onset of a myasthenic crisis can result from various triggers, including respiratory infections caused by coronavirus disease 2019. Case Report: We present a case report detailing the management of a 43-year-old Asian woman with acute exacerbation of myasthenia gravis due to coronavirus disease 2019. The patient was at risk of intubation due to respiratory compromise. Plasmapheresis, a method involving the removal and screening of harmful antibodies, was initiated on the fourth hospital day due to worsening respiratory status despite maximal medical management. Five sessions led to marked improvement and prevented the need for intubation. Conclusion: Early plasmapheresis can be effective in managing MG exacerbations in severe coronavirus disease 2019 and may prevent intubation when initiated in the appropriate clinical context. This intervention demonstrated notable success in addressing respiratory distress, suggesting its viability as a therapeutic approach in similar scenarios.