{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:08:30Z","timestamp":1753891710895,"version":"3.41.2"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T00:00:00Z","timestamp":1655769600000},"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. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The COVID-19 disease can affect subjects suffering from myasthenia gravis (MG) and worsen its clinical course, leading to intensive care unit (ICU) admission. Critically ill subjects can develop a neuromuscular complication called ICU-acquired weakness (ICUAW). This disorder has also been detected in ICU subjects with COVID-19, but the association between MG and ICUAW has never been described in critically ill patients. We describe the case and functional outcome of a COVID-19 patient suffering from MG who developed critical illness polyneuropathy (CIP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Presentation<\/jats:title><jats:p>A 66-year-old man with a history of hypertension and ocular MG had COVID-19 and required ICU admission. The patient underwent mechanical ventilation and tracheotomy and was treated with remdesivir and corticosteroids. Fifteen days after admission, he complained of tetraparesis without the ocular involvement that remained unchanged despite the increase in anticholinesterase therapy. The length of stay (LOS) in ICU was 35 days. On day 2 of admission, the patient underwent a frontal muscle jitter study that confirmed the MG, and electroneurography (ENG) and electromyography (EMG) that showed overlapping ICUAW with electrophysiological signs characteristic of CIP. The cerebrospinal fluid (CSF) showed normal pressure, cell count, and protein levels (&amp;lt;45 mg\/dl) without albumin-cytologic disassociation. The CSF\/serum glucose ratio was normal. The CSF culture for possible organisms, laboratory tests for autoimmune disorders, the panel of antiganglioside antibodies, and the paraneoplastic syndrome were negative. Strength and functional outcomes were tested with the MRC scale, the DRS, Barthel scale, and the Functional Independence Measure (FIM) at admission, discharge, and follow-up. Muscular strength improved progressively, and the MRC scale sum-score was 50 at discharge. Anticholinesterase therapy with pyridostigmine at a dosage of 30 mg 3 times daily, which the patient was taking before COVID-19, was resumed. His motor abilities recovered, and functional evaluations showed full recovery at follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In the described subject, the coexistence of both neuromuscular disorders did not affect the clinical course and recovery, but the question remains about generalization to all patients with MG. The rehabilitation interventions might have facilitated the outcome.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2022.906402","type":"journal-article","created":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T06:08:10Z","timestamp":1655791690000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Functional Outcome of COVID-19 Subjects With Myasthenia Gravis and Critical Illness Polyneuropathy"],"prefix":"10.3389","volume":"13","author":[{"given":"Domenico","family":"Intiso","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonello Marco","family":"Centra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Amoruso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Gravina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filomena Di","family":"Rienzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"117263","DOI":"10.1016\/j.jns.2020.117263","article-title":"GuillainBarr\u00e9 Syndrome and its variants as a manifestation of COVID-19: a systematic review of case reports and case series","volume":"420","author":"Sriwastava","year":"2021","journal-title":"J Neurol Sci."},{"key":"B2","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1007\/s11910-021-01102-5","article-title":"Peripheral Nervous System Manifestations Associated with COVID-19","volume":"21","author":"Andalib","year":"2021","journal-title":"Curr Neurol Neurosci Rep."},{"key":"B3","doi-asserted-by":"publisher","first-page":"pzaa191","DOI":"10.1093\/ptj\/pzaa191","article-title":"Brachial plexus neuropathies during the COVID-19 pandemic: a retrospective case series of 15 patients in critical care","volume":"101","author":"Miller","year":"2021","journal-title":"Phys Ther"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e244146","DOI":"10.1136\/bcr-2021-244146","article-title":"Temporal association between SARS-CoV-2 and new-onset myasthenia gravis: is it causal or coincidental?","volume":"14","author":"Muralidhar Reddy YB","year":"2021","journal-title":"BMJ Case Rep."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.7326\/L20-0845","article-title":"Myasthenia gravis associated with SARS-CoV-2 infection","volume":"173","author":"Restivo","year":"2020","journal-title":"Ann Intern Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2690","DOI":"10.1007\/s00415-020-10263-1","article-title":"New onset of ocular myasthenia gravis in a patient with COVID-19: a novel case report and literature review","volume":"268","author":"Sriwastava","year":"2021","journal-title":"J Neurols"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10072-021-05823-w","article-title":"Myasthenia gravis exacerbation and myasthenic crisis associated with COVID-19: case series and literature review","volume":"18","author":"Rodrigues","year":"2022","journal-title":"Neurol Sci."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.3389\/fneur.2020.01053","article-title":"Myasthenia gravis and COVID-19: clinical characteristics and outcomes","volume":"11","author":"Camelo-Filho","year":"2020","journal-title":"Front Neurol."},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(11)70178-8","article-title":"Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis","author":"Latronico","year":"2011","journal-title":"Lancet Neurol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2083","DOI":"10.1007\/s00134-020-06244-7","article-title":"COVID-19 Consortium. Intensive care unit acquired muscle weakness in COVID-19 patients","volume":"46","author":"Van Aerde","year":"2020","journal-title":"Intensive Care Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"872","DOI":"10.7326\/L20-1298","article-title":"MuSK Antibody-associated myasthenia gravis with SARS-CoV-2 infection: a case report","volume":"6","author":"Muhammed","year":"2021","journal-title":"Ann Intern Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"3537","DOI":"10.1111\/ene.14721","article-title":"Myasthenia gravis associated with anti-MuSK antibodies developed after SARS-CoV-2 infection","volume":"10","author":"Assini","year":"2021","journal-title":"Eur J Neurol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1002\/mus.27324","article-title":"COVID-19 in patients with myasthenia gravis: epidemiology and disease course","volume":"64","author":"Businaro","year":"2021","journal-title":"Muscle Nerve."},{"key":"B14","doi-asserted-by":"publisher","first-page":"3418","DOI":"10.1111\/ene.14951","article-title":"Predictive factors for a severe course of COVID-19 infection in myasthenia gravis patients with an overall impact on myasthenic outcome status and survival","volume":"28","author":"Jakub\u00edkov\u00e1","year":"2021","journal-title":"Eur J Neurol."},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008688","article-title":"Myasthenic crisis demanding mechanical ventilation: a multicenter analysis of 250 cases","author":"Neumann","year":"2020","journal-title":"Neurology"},{"key":"B16","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1186\/s12974-022-02448-4","article-title":"Independent risk factors for myasthenic crisis and disease exacerbation in a retrospective cohort of myasthenia gravis patients","volume":"19","author":"Nelke","year":"2022","journal-title":"J Neuroinflam"},{"key":"B17","doi-asserted-by":"publisher","first-page":"802559","DOI":"10.3389\/fneur.2022.802559","article-title":"COVID-19 Outcomes in myasthenia gravis patients: analysis from electronic health records in the United States","volume":"13","author":"Kim Youngran","year":"2022","journal-title":"Front Neurol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"107140","DOI":"10.1016\/j.clineuro.2022.107140","article-title":"Characteristics, treatment, and outcomes of myasthenia gravis in COVID-19 patients: a systematic review","volume":"213","author":"Abbas","year":"2022","journal-title":"ClinNeurolNeurosurg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1002\/mus.27497","article-title":"Clinical course and outcome of an outpatient clinic population with myasthenia gravis and COVID-19","volume":"65","author":"Tuncer","year":"2022","journal-title":"Muscle Nerve."},{"key":"B20","doi-asserted-by":"publisher","first-page":"406","DOI":"10.3390\/neurolint14020033","article-title":"Impact of COVID-19 in AChR myasthenia gravis and the safety of vaccines: data from an Italian cohort","volume":"14","author":"Lupica","year":"2022","journal-title":"Neurol Int."},{"key":"B21","doi-asserted-by":"publisher","first-page":"733418","DOI":"10.3389\/fimmu.2021.733418","article-title":"To be or not to be vaccinated: that is a question in myasthenia gravis","volume":"12","author":"Zhou","year":"2021","journal-title":"Front Immunol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1437","DOI":"10.1164\/rccm.201411-2011ST","article-title":"An official American Thoracic Society Clinical Practice guideline: the diagnosis of intensive care unit-acquired weakness in adults","volume":"190","author":"Fan","year":"2014","journal-title":"Am J RespirCrit Care Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"jrm00257","DOI":"10.2340\/jrm.v53.1139","article-title":"Critical illness polyneuropathy and functional outcome in subjects with COVID-19: report on four patients and a scoping review of the literature","volume":"54","author":"Intiso","year":"2022","journal-title":"J Rehabil Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/s12883-022-02570-z","article-title":"Recovery and long term functional outcome in people with critical illness polyneuropathy and myopathy: a scoping review","volume":"22","author":"Intiso","year":"2022","journal-title":"BMC Neurol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1007\/s00415-020-10064-6","article-title":"Significant reduction of physical activity in patients with neuromuscular disease during COVID-19 pandemic: the long-term consequences of quarantine","volume":"268","author":"Di Stefano","year":"2021","journal-title":"J Neurol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1136\/jnnp-2019-322606","article-title":"Rodolico C. Rituximab in AChR subtype of myastheniagravis: systematic review","volume":"91","author":"Di Stefano","year":"2020","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1016\/S0140-6736(20)30628-0","article-title":"COVID-19: consider cytokine storm syndromes and immunosuppression","volume":"395","author":"Mehta","year":"2020","journal-title":"Lancet."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.906402\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T06:08:12Z","timestamp":1655791692000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.906402\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,21]]},"references-count":27,"alternative-id":["10.3389\/fneur.2022.906402"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2022.906402","relation":{},"ISSN":["1664-2295"],"issn-type":[{"type":"electronic","value":"1664-2295"}],"subject":[],"published":{"date-parts":[[2022,6,21]]},"article-number":"906402"}}