To summarize characteristics, managements, and outcomes of patients with myasthenia gravis (MG) infected with COVID-19, and to report outcomes of patients with MG infected with COVID-19 who received azithromycin (AZM) or hydroxychloroquine (HCQ).

Acute viral infection is associated with weakness exacerbation in patients with MG. COVID-19 is a current major cause of viral infection and hospitalization around the world. We aim to summarize characteristics and outcomes of patients with previous diagnosis of MG that had severe infections with COVID-19. We also report outcomes associated with HCQ and AZM use in MG patients, since they can precipitate MG exacerbations.

We conducted a literature review for case reports and series of COVID-19 in patients with MG requiring hospitalization from May 2020 to July 2021 using PubMed. Patient demographics, management, and outcomes data were extracted to produce aggregate measures. This included outcomes after AZM and HCQ use in a subset of patients.

30 articles were identified, yielding 58 cases. 54% were female, and the average age at presentation was 55 years. 28 (48%) presented with acute MG exacerbation. The most common MG treatment change was the addition or increase in dose of a corticosteroid (27%), and the addition of IVIG (23%). 27 patients (47%) required mechanical ventilation (MV), 6 patients (10%) died, and 48 patients (83%) recovered. 5 out of 7 patients (71%) who received HCQ required MV and 0 died. 11 out of 20 patients (55%) who received AZM required MV and 3 (15%) died.

MG patients with severe COVID-19 infections have high rates of MV (47%) but favorable outcomes with regards to mortality (10%). Unsurprisingly, treatment with AZM and HCQ was associated with higher rates of MV.