Does the virus or the doctor promote myasthenic crises in COVID-19 patients with myasthenia?

• Published in: Journal of clinical anesthesia Vol. 70; p. 110166
• Main Authors: Finsterer, J., Ghosh, R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2021; Elsevier Limited
• Subjects: Coronaviruses; Correspondence; COVID-19; Crisis; Drug dosages; Electromyography; Encephalitis; Exacerbation; Guillain-Barre syndrome; Humans; Infection; Muscle Weakness; Myasthenia; Myasthenia Gravis - complications; Neuromuscular transmission; Patients; Pneumonia; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Side effects; Exacerbation; Infection; Side effects; Myasthenia; Neuromuscular transmission; Crisis
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2021.110166

The third shortcoming is that the patient received drugs which are well-known to potentially exacerbate MG. Since azithromycin may trigger MG (odds ratio 1.42) [2], salient information regarding dosage and duration of therapy with azithromycin alongside pin-pointing whether pneumonia or the drugs precipitated the need for re-intubation should have been more clearly depicted. Readers must be made aware of the facts whether GBS with involvement of the phrenic nerve and Bickerstaff encephalitis were appropriately excluded by nerve conduction studies, relevant neuroimaging, and investigation of the cerebro-spinal fluid (CSF). Since the patient underwent long-term treatment on an ICU, it should be also excluded that the relapse was due to critical illness neuropathy or critical illness myopathy. The study was approved by the institutional review board.Declaration of Competing Interest The authors declare no conflicts of interest.