{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T05:21:03Z","timestamp":1765862463797,"version":"3.48.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T00:00:00Z","timestamp":1765843200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Muscle-specific kinase (MuSK) myasthenia gravis is a rare autoimmune disorder of the neuromuscular junction that predominantly affects the bulbar and respiratory muscles. Although SARS-CoV-2 infection has been implicated as a precipitating factor, post-COVID-19 MuSK-MG remains exceedingly uncommon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 29-year-old woman with a six-year history of unexplained exertional dyspnea was hospitalised twice for acute hypercapnic respiratory failure. The first episode, five months earlier, was attributed to severe tricuspid regurgitation; the second occurred eight weeks after mild COVID-19 and was characterized by coma due to hypercapnic respiratory failure without parenchymal lung disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Diagnosis<\/jats:title>\n                    <jats:p>Standard electrophysiology, neostigmine testing and acetylcholine-receptor antibodies (AChR-Ab) were negative. Given persistent ventilator dependence, MuSK antibodies (MuSK-Ab) were measured and found strongly positive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>The patient underwent five plasma-exchange sessions, then received oral prednisone (50 mg day), tacrolimus (1.5 mg q12h) and nebulized salbutamol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>She was weaned from non-invasive ventilation by day 23, discharged on day 27 (mMRC grade I) and remained stable on low-dose prednisone\/tacrolimus at three-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SARS-CoV-2 infection may plausibly act as a trigger for late-onset MuSK-MG presenting as isolated hypercapnic respiratory failure. In otherwise unexplained weaning failure, neuromuscular-junction disease should be considered even without limb or ocular weakness. Early antibody testing and prompt immunomodulatory therapy [plasma exchange (PLEX) plus glucocorticoid\/tacrolimus] may be life-saving and yield rapid recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2025.1649930","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T05:17:35Z","timestamp":1765862255000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["COVID-19\u2013associated delayed-onset MuSK-positive myasthenia gravis presenting solely with respiratory failure: a case 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