Description of 3 patients with myasthenia gravis and COVID-19.
Identifieur interne : 000917 ( Main/Corpus ); précédent : 000916; suivant : 000918Description of 3 patients with myasthenia gravis and COVID-19.
Auteurs : Netaniel Rein ; Nitzan Haham ; Efrat Orenbuch-Harroch ; Marc Romain ; Zohar Argov ; Adi Vaknin-Dembinsky ; Marc GotkineSource :
- Journal of the neurological sciences [ 1878-5883 ] ; 2020.
English descriptors
- KwdEn :
- Adult (MeSH), Aged (MeSH), Azithromycin (therapeutic use), Betacoronavirus (MeSH), Coronavirus Infections (complications), Coronavirus Infections (drug therapy), Diabetes Mellitus, Type 2 (complications), Female (MeSH), Humans (MeSH), Hydroxychloroquine (therapeutic use), Hypertension (complications), Hypothyroidism (complications), Immunocompromised Host (MeSH), Immunoglobulins, Intravenous (therapeutic use), Immunosuppressive Agents (adverse effects), Immunosuppressive Agents (therapeutic use), Lopinavir (therapeutic use), Male (MeSH), Myasthenia Gravis (complications), Myasthenia Gravis (drug therapy), Myasthenia Gravis (therapy), Pandemics (MeSH), Plasmapheresis (MeSH), Pneumonia, Viral (complications), Pneumonia, Viral (drug therapy), Ritonavir (therapeutic use), Treatment Outcome (MeSH).
- MESH :
- chemical , adverse effects : Immunosuppressive Agents.
- chemical , therapeutic use : Azithromycin, Hydroxychloroquine, Immunoglobulins, Intravenous, Immunosuppressive Agents, Lopinavir, Ritonavir.
- complications : Coronavirus Infections, Diabetes Mellitus, Type 2, Hypertension, Hypothyroidism, Myasthenia Gravis, Pneumonia, Viral.
- drug therapy : Coronavirus Infections, Myasthenia Gravis, Pneumonia, Viral.
- therapy : Myasthenia Gravis.
- Adult, Aged, Betacoronavirus, Female, Humans, Immunocompromised Host, Male, Pandemics, Plasmapheresis, Treatment Outcome.
Abstract
BACKGROUND
The COVID-19 pandemic presents two main concerns for patients with myasthenia gravis (MG); chronic immunosuppression may put them at greater risk, and some proposed treatments for COVID-19 could cause MG exacerbation.
CASE DESCRIPTION
We present three patients with generalized seropositive MG who developed COVID-19. All patients had a favorable outcome, with only one patient experiencing exacerbation. In this case, exacerbation began before COVID-19; she required ICU admission, non-invasive ventilatory support, and received hydroxychloroquine, lopinavir and ritonavir which were well tolerated. One patient received IVIG in place of scheduled plasma exchange.
CONCLUSION
Outcome was favorable in all cases despite immunosuppressive therapy, use of experimental COVID-19 medication and switching of plasma exchange for IVIG.
DOI: 10.1016/j.jns.2020.117053
PubMed: 32731059
Links to Exploration step
pubmed:32731059Le document en format XML
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Electronic address: Nitan.haham@mail.huji.ac.il.</nlm:affiliation></affiliation></author><author><name sortKey="Orenbuch Harroch, Efrat" sort="Orenbuch Harroch, Efrat" uniqKey="Orenbuch Harroch E" first="Efrat" last="Orenbuch-Harroch">Efrat Orenbuch-Harroch</name><affiliation><nlm:affiliation>Hadassah-Hebrew University Medical Center, Medical intensive care unit, Jerusalem, Israel.</nlm:affiliation></affiliation></author><author><name sortKey="Romain, Marc" sort="Romain, Marc" uniqKey="Romain M" first="Marc" last="Romain">Marc Romain</name><affiliation><nlm:affiliation>Hadassah-Hebrew University Medical Center, Medical intensive care unit, Jerusalem, Israel. 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Electronic address: zohara@ekmd.huji.ac.il.</nlm:affiliation></affiliation></author><author><name sortKey="Vaknin Dembinsky, Adi" sort="Vaknin Dembinsky, Adi" uniqKey="Vaknin Dembinsky A" first="Adi" last="Vaknin-Dembinsky">Adi Vaknin-Dembinsky</name><affiliation><nlm:affiliation>Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel.</nlm:affiliation></affiliation></author><author><name sortKey="Gotkine, Marc" sort="Gotkine, Marc" uniqKey="Gotkine M" first="Marc" last="Gotkine">Marc Gotkine</name><affiliation><nlm:affiliation>Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel. 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Electronic address: Netaniel.rein@mail.huji.ac.il.</nlm:affiliation></affiliation></author><author><name sortKey="Haham, Nitzan" sort="Haham, Nitzan" uniqKey="Haham N" first="Nitzan" last="Haham">Nitzan Haham</name><affiliation><nlm:affiliation>Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel. Electronic address: Nitan.haham@mail.huji.ac.il.</nlm:affiliation></affiliation></author><author><name sortKey="Orenbuch Harroch, Efrat" sort="Orenbuch Harroch, Efrat" uniqKey="Orenbuch Harroch E" first="Efrat" last="Orenbuch-Harroch">Efrat Orenbuch-Harroch</name><affiliation><nlm:affiliation>Hadassah-Hebrew University Medical Center, Medical intensive care unit, Jerusalem, Israel.</nlm:affiliation></affiliation></author><author><name sortKey="Romain, Marc" sort="Romain, Marc" uniqKey="Romain M" first="Marc" last="Romain">Marc Romain</name><affiliation><nlm:affiliation>Hadassah-Hebrew University Medical Center, Medical intensive care unit, Jerusalem, Israel. Electronic address: Marcro@hadassah.org.il.</nlm:affiliation></affiliation></author><author><name sortKey="Argov, Zohar" sort="Argov, Zohar" uniqKey="Argov Z" first="Zohar" last="Argov">Zohar Argov</name><affiliation><nlm:affiliation>Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel. Electronic address: zohara@ekmd.huji.ac.il.</nlm:affiliation></affiliation></author><author><name sortKey="Vaknin Dembinsky, Adi" sort="Vaknin Dembinsky, Adi" uniqKey="Vaknin Dembinsky A" first="Adi" last="Vaknin-Dembinsky">Adi Vaknin-Dembinsky</name><affiliation><nlm:affiliation>Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel.</nlm:affiliation></affiliation></author><author><name sortKey="Gotkine, Marc" sort="Gotkine, Marc" uniqKey="Gotkine M" first="Marc" last="Gotkine">Marc Gotkine</name><affiliation><nlm:affiliation>Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel. Electronic address: marc@gotkine.com.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Journal of the neurological sciences</title><idno type="eISSN">1878-5883</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Aged (MeSH)</term><term>Azithromycin (therapeutic use)</term><term>Betacoronavirus (MeSH)</term><term>Coronavirus Infections (complications)</term><term>Coronavirus Infections (drug therapy)</term><term>Diabetes Mellitus, Type 2 (complications)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Hydroxychloroquine (therapeutic use)</term><term>Hypertension (complications)</term><term>Hypothyroidism (complications)</term><term>Immunocompromised Host (MeSH)</term><term>Immunoglobulins, Intravenous (therapeutic use)</term><term>Immunosuppressive Agents (adverse effects)</term><term>Immunosuppressive Agents (therapeutic use)</term><term>Lopinavir (therapeutic use)</term><term>Male (MeSH)</term><term>Myasthenia Gravis (complications)</term><term>Myasthenia Gravis (drug therapy)</term><term>Myasthenia Gravis (therapy)</term><term>Pandemics (MeSH)</term><term>Plasmapheresis (MeSH)</term><term>Pneumonia, Viral (complications)</term><term>Pneumonia, Viral (drug therapy)</term><term>Ritonavir (therapeutic use)</term><term>Treatment Outcome (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Immunosuppressive Agents</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Azithromycin</term><term>Hydroxychloroquine</term><term>Immunoglobulins, Intravenous</term><term>Immunosuppressive Agents</term><term>Lopinavir</term><term>Ritonavir</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Coronavirus Infections</term><term>Diabetes Mellitus, Type 2</term><term>Hypertension</term><term>Hypothyroidism</term><term>Myasthenia Gravis</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Coronavirus Infections</term><term>Myasthenia Gravis</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Myasthenia Gravis</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Betacoronavirus</term><term>Female</term><term>Humans</term><term>Immunocompromised Host</term><term>Male</term><term>Pandemics</term><term>Plasmapheresis</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>The COVID-19 pandemic presents two main concerns for patients with myasthenia gravis (MG); chronic immunosuppression may put them at greater risk, and some proposed treatments for COVID-19 could cause MG exacerbation.</p></div><div type="abstract" xml:lang="en"><p><b>CASE DESCRIPTION</b></p><p>We present three patients with generalized seropositive MG who developed COVID-19. All patients had a favorable outcome, with only one patient experiencing exacerbation. In this case, exacerbation began before COVID-19; she required ICU admission, non-invasive ventilatory support, and received hydroxychloroquine, lopinavir and ritonavir which were well tolerated. One patient received IVIG in place of scheduled plasma exchange.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Outcome was favorable in all cases despite immunosuppressive therapy, use of experimental COVID-19 medication and switching of plasma exchange for IVIG.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32731059</PMID><DateCompleted><Year>2020</Year><Month>09</Month><Day>25</Day></DateCompleted><DateRevised><Year>2020</Year><Month>09</Month><Day>25</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1878-5883</ISSN><JournalIssue CitedMedium="Internet"><Volume>417</Volume><PubDate><Year>2020</Year><Month>10</Month><Day>15</Day></PubDate></JournalIssue><Title>Journal of the neurological sciences</Title><ISOAbbreviation>J Neurol Sci</ISOAbbreviation></Journal><ArticleTitle>Description of 3 patients with myasthenia gravis and COVID-19.</ArticleTitle><Pagination><MedlinePgn>117053</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0022-510X(20)30390-7</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.jns.2020.117053</ELocationID><Abstract><AbstractText Label="BACKGROUND">The COVID-19 pandemic presents two main concerns for patients with myasthenia gravis (MG); chronic immunosuppression may put them at greater risk, and some proposed treatments for COVID-19 could cause MG exacerbation.</AbstractText><AbstractText Label="CASE DESCRIPTION">We present three patients with generalized seropositive MG who developed COVID-19. All patients had a favorable outcome, with only one patient experiencing exacerbation. In this case, exacerbation began before COVID-19; she required ICU admission, non-invasive ventilatory support, and received hydroxychloroquine, lopinavir and ritonavir which were well tolerated. One patient received IVIG in place of scheduled plasma exchange.</AbstractText><AbstractText Label="CONCLUSION">Outcome was favorable in all cases despite immunosuppressive therapy, use of experimental COVID-19 medication and switching of plasma exchange for IVIG.</AbstractText><CopyrightInformation>Copyright © 2020 Elsevier B.V. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Rein</LastName><ForeName>Netaniel</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel. Electronic address: Netaniel.rein@mail.huji.ac.il.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Haham</LastName><ForeName>Nitzan</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel. Electronic address: Nitan.haham@mail.huji.ac.il.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Orenbuch-Harroch</LastName><ForeName>Efrat</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Hadassah-Hebrew University Medical Center, Medical intensive care unit, Jerusalem, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Romain</LastName><ForeName>Marc</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Hadassah-Hebrew University Medical Center, Medical intensive care unit, Jerusalem, Israel. Electronic address: Marcro@hadassah.org.il.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Argov</LastName><ForeName>Zohar</ForeName><Initials>Z</Initials><AffiliationInfo><Affiliation>Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel. Electronic address: zohara@ekmd.huji.ac.il.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vaknin-Dembinsky</LastName><ForeName>Adi</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gotkine</LastName><ForeName>Marc</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Hadassah-Hebrew University Medical Center, Department of Neurology, the Agnes-Ginges Center for Neurogenetics Jerusalem, Israel. Electronic address: marc@gotkine.com.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>07</Month><Day>22</Day></ArticleDate></Article><MedlineJournalInfo><Country>Netherlands</Country><MedlineTA>J Neurol Sci</MedlineTA><NlmUniqueID>0375403</NlmUniqueID><ISSNLinking>0022-510X</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D016756">Immunoglobulins, Intravenous</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007166">Immunosuppressive Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>2494G1JF75</RegistryNumber><NameOfSubstance UI="D061466">Lopinavir</NameOfSubstance></Chemical><Chemical><RegistryNumber>4QWG6N8QKH</RegistryNumber><NameOfSubstance UI="D006886">Hydroxychloroquine</NameOfSubstance></Chemical><Chemical><RegistryNumber>83905-01-5</RegistryNumber><NameOfSubstance UI="D017963">Azithromycin</NameOfSubstance></Chemical><Chemical><RegistryNumber>O3J8G9O825</RegistryNumber><NameOfSubstance UI="D019438">Ritonavir</NameOfSubstance></Chemical></ChemicalList><SupplMeshList><SupplMeshName Type="Disease" UI="C000657245">COVID-19</SupplMeshName><SupplMeshName Type="Protocol" UI="C000705127">COVID-19 drug treatment</SupplMeshName><SupplMeshName Type="Organism" UI="C000656484">severe acute respiratory syndrome coronavirus 2</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017963" MajorTopicYN="N">Azithromycin</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="Y">Betacoronavirus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003924" MajorTopicYN="N">Diabetes Mellitus, Type 2</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006886" MajorTopicYN="N">Hydroxychloroquine</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006973" MajorTopicYN="N">Hypertension</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007037" MajorTopicYN="N">Hypothyroidism</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016867" MajorTopicYN="N">Immunocompromised Host</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016756" MajorTopicYN="N">Immunoglobulins, Intravenous</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007166" MajorTopicYN="N">Immunosuppressive Agents</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D061466" MajorTopicYN="N">Lopinavir</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009157" MajorTopicYN="N">Myasthenia Gravis</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="Y">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010956" MajorTopicYN="N">Plasmapheresis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D019438" MajorTopicYN="N">Ritonavir</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">COVID-19</Keyword><Keyword MajorTopicYN="Y">Myasthenia</Keyword><Keyword MajorTopicYN="Y">Neuroimmunology</Keyword><Keyword MajorTopicYN="Y">Neuromuscular</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>05</Month><Day>15</Day></PubMedPubDate><PubMedPubDate 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