• Sachin M Bhagavan, Swathi Beladakere Ramaswamy, and Raghav Govindarajan.
• Department of Neurology, University of Missouri Health Care, Missouri.
• Medicine (Baltimore). 2021 May 7; 100 (18): e25701e25701.

RationaleMyasthenia gravis (MG) patients are at increased risk of COVID-19 infection and its complications due to chronic immunosuppression. COVID-19 infection can also increase the risk of myasthenia exacerbation.Patient ConcernsThe patient presented with respiratory distress, fever and chills and was diagnosed with COVID-19 pneumonia. His past medical history includes seropositive generalized MG diagnosed in 2019, hypertension, atrial fibrillation and congestive heart failure with reduced ejection failure.DiagnosesRefractory seropositive generalized MG having COVID-19 pneumonia and respiratory failure (needing mechanical ventilation) with sepsis.InterventionUse of intravenous remdesivir and dexamethasone and patient's myasthenic exacerbation (due to COVID-19 and its complications) was successfully treated with plasmapheresis.OutcomesPatient was successfully weaned off ventilator to trach collar and was discharged to inpatient rehabiliation. He was followed up 1 month post hospital discharge and was on trach collar.LessonsThis case report illustrates early use of the combination therapy might be beneficial in refractory myasthenia gravis cases even with chronic immunosuppression and severe COVID-19 infection.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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