CASE REPORT

Myasthenia gravis and arrhythmias in COVID-19: a case report

Dodik Tugasworo , Aditya Kurnianto, Retnaningsih Retnaningsih, Yovita Andhitara, Rahmi Ardhini, Daynuri Daynuri, Jethro Budiman

Dodik Tugasworo
Department of Neurology, Faculty of Medicine, Universitas Diponegoro-Dr. Kariadi Hospital, Semarang, Indonesia. Email: [email protected]

Aditya Kurnianto
Department of Neurology, Faculty of Medicine, Universitas Diponegoro-Dr. Kariadi Hospital, Semarang, Indonesia

Retnaningsih Retnaningsih
Department of Neurology, Faculty of Medicine, Universitas Diponegoro-Dr. Kariadi Hospital, Semarang, Indonesia

Yovita Andhitara
Department of Neurology, Faculty of Medicine, Universitas Diponegoro-Dr. Kariadi Hospital, Semarang, Indonesia

Rahmi Ardhini
Department of Neurology, Faculty of Medicine, Universitas Diponegoro-Dr. Kariadi Hospital, Semarang, Indonesia

Daynuri Daynuri
Department of Neurology, Faculty of Medicine, Universitas Diponegoro-Dr. Kariadi Hospital, Semarang, Indonesia

Jethro Budiman
Department of Neurology, Faculty of Medicine, Universitas Diponegoro-Dr. Kariadi Hospital, Semarang, Indonesia
Online First: April 30, 2021 | Cite this Article
Tugasworo, D., Kurnianto, A., Retnaningsih, R., Andhitara, Y., Ardhini, R., Daynuri, D., Budiman, J. 2021. Myasthenia gravis and arrhythmias in COVID-19: a case report. Bali Medical Journal 10(1): 314-319. DOI:10.15562/bmj.v10i1.2168


Background: Myasthenia Gravis (MG) is an autoimmune disorder, which autoantibodies against postsynaptic (muscle) nicotinic acetylcholine receptors (nAChR). MG patients have a higher prevalence of cardiac manifestations in the presence of thymoma. It is not known whether Coronavirus disease 2019 (COVID-19) can cause more severe illness in patients with chronic neuromuscular disorders such as MG, which can cause respiratory muscle weakness, or in those who are immunosuppressed. This case report will discuss patient with MG, thymoma, atrial fibrillation, and COVID-19.

Case presentation:  A 60-year old man came to the hospital with difficulty of swallowing. He had nasal voice and dropping of eyelids. These complaints were happened repeatedly, worsened at night and got better in the next morning. From the neurological examination, it was also obtained Wartenberg test (+), counting test (+), and prostigmine test (+). Atrial fibrillation was found with normal ventricular response and decreased systolic left ventricular function on the electrocardiogram and echocardiography. On the chest MSCT, a lobulated homogeneous solid mass was found in anterior mediastinum which supported the image of thymoma, and there was the imaging of typical viral pneumonia. The patient also had the positive result of COVID-19 PCR test.

Conclusion: MG patients have been shown with abnormal manifestations of heart rhythm. This may reflect as a complication of myocarditis or autonomic nervous system dysfunction. COVID-19 infection in MG can be challenging for many reasons. Current guidelines recommend continuing the current standard care treatment of MG during hospitalization.

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