The rates of complications and death related to COVID-19 were high in a cohort of patients with myasthenia gravis (MG), researchers recently reported. Some patients also had MG exacerbations during SARS-CoV-2 infections. 

“Further studies are needed to determine whether MG patients are at higher risk for complications than the rest of the population,” the authors of the study wrote in a report published in Muscle and Nerve.

To identify the potential risk factors that may exacerbate the disease in MG patients, a team of researchers led by Rocio Garcia-Santibanez, MD, from the department of neurology, Emory University School of Medicine, Atlanta, Georgia, retrospectively analyzed outcomes in 39 MG patients, with an average age of 52.6  years, infected with SARS-CoV-2 between March 1, 2020, and October 25, 2021.

Of these 39 patients, 8 were vaccinated against COVID-19 while 30 were unvaccinated. The vaccination status of 1 patient was unknown. A total of 27 patients were receiving immunomodulatory treatments at the time of SARS-CoV-2 infection. 

Following the infection, the majority of patients (35) showed symptoms of COVID-19 and 21 were hospitalized with 7 requiring ventilation. 

MG exacerbations occurred in 5 patients. Of these 1 was treated with therapeutic plasma exchange, 1 with intravenous immunoglobulin, and all were given prednisone taper. 

Read more about the complications of MG

Of the hospitalized 21 patients, 4 died due to COVID-19-related lung injuries. None of the deaths were attributed to MG exacerbations even though 1 patient receiving intravenous immunoglobulin for MG exacerbation had a pulmonary embolism. 

None of the fully-vaccinated patients died, and only 1 such patient was admitted to the intensive care unit.

“Some limited, preliminary recommendations about short-term COVID-19 treatment may be made from the data presented and may be used in conjunction with existing guidelines on [the] management of COVID-19 in MG patients,” the researchers concluded.


Thomas EV, Bou G, Barton S, Hutto S, Garcia-Santibanez R. COVID-19 infection in myasthenia gravis: clinical course and outcomes. Muscle Nerve. 2023;68(2):171-175. doi:10.1002/mus.27919