CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1596283
Case Series : Eculizumab In Highly Active Myasthenia Gravis Complicated by Severe Infections
Provisionally accepted
Yufei Deng
Haocheng Luo
Chaoyue ZhangLi YangShuangshuang WangXuxiang ZhangXianni YanXiaojun Yang
Qilong Jiang*- The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
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Highly active myasthenia gravis refers to a subset of refractory patients who exhibit recurrent exacerbations and crises. Eculizumab, a complement C5 inhibitor, has shown its efficacy and safety for patients with anti-acetylcholine receptor antibody-positive(AchR +)refractory generalized myasthenia gravis(gMG)in the REGAIN trial. However, the efficacy and safety of eculizumab in treating MG patients with severe infections have not yet been supported by clinical evidence. This is a case series reporting four patients with highly active myasthenia gravis complicated by severe infections. Changes in Myasthenia Gravis-Activities of Daily Living (MG-ADL) and Quantitative Myasthenia Gravis (QMG) scores were recorded before and after 12 injections of eculizumab to assess efficacy. Pathogen characteristics of infections were summarized using bacterial culture and next-generation sequencing (NGS) results, presented as a heatmap to illustrate pathogen species and abundance. Inflammatory markers, including Procalcitonin (PCT), C-Reactive Protein (CRP), neutrophil count, and total lymphocyte count, were monitored to evaluate the safety. Treatment regimens were retrospectively analyzed to further assess clinical outcomes and safety. The baseline ADL data for the four patients was 22±2.31(Mean±SD), and the baseline QMG data was 30.5±8.23. After 12 injections of eculizumab treatment, the scores decreased to ADL 4.75±3.3 and QMG 14±3.37. During the treatment , no apparent worsening of infections related to Eculizumab was noted. Three patients successfully had their tracheostomy tubes removed, and none of the four patients experienced further myasthenic crises.Eculizumab demonstrated clinical improvement in this series, and the treatment was well-tolerated. This case series addresses the need for data on complement inhibitors 3226 删除[yufei deng]: in highly active myasthenia gravis patients with severe infections, provides clinical reference support for the expanded application of eculizumab.
Keywords: Eculizumab, Highly active myasthenia gravis, Severe infections, case series, Complement inhibition; Abstract：
Received: 19 Mar 2025; Accepted: 07 Jul 2025.
Copyright: © 2025 Deng, Luo, Zhang, Yang, Wang, Zhang, Yan, Yang and Jiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qilong Jiang, The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
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