Myasthenia gravis (MG) is an autoimmune neuromuscular disorder characterized by muscle weakness and fatigue.
Late-onset myasthenia gravis refers to cases where the symptoms develop after the age of 50.It is believed that the systemic inflammation and immune response triggered by a COVID-19 infection can precipitate MG symptoms. An 83-year-old man presented with diplopia and bulbar weakness, from elevated blood pressure he had no history of disorders.The search for AChR antibody showed mild elevation title.He underwent spirometry and CT for thymus that showed possible residual thymus,surgery was not advised.He with Mestinon 60 mg three times daily ha some improvement and alternate day steroid was advised for IVIg treatment he was able to obtain in-hospita. He refused to try azathioprine.
In December of 2024 his daughter contracted Covid-19 infection because of travelling.He was not recently vaccinated and because of close contact a sudden infection.
On 17 December he was hospitalized for respiratory insufficiency and intubated in the Intensive Care Unit where Remedivir treatment was started,and Medrol 250 mg given with another IVIg cycle.
The patient was able to raise his arm MRC strength in upper extremity muscles 4/5lower limbs 3/5. On 23 December extubation was tried,but failed because of bulbar weakness and a concomitant respiratory infection with dense mucus.
After another weak in ICU he became restless so a second extubation was tried on January 2024 that was successful.
He presented atrial fibrillation that was treated with digitalis he refused cardioversion with propofol. On January 4 he accepted cardioversion procedure successfully done, and was rescued.