Case Presentation: 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 (<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.
Conclusion: 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.