CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
This article is part of the Research TopicCase Reports in Autoimmune and Autoinflammatory Disorders: Volume IIView all 40 articles
COVID-19–Associated Delayed-Onset MuSK-Positive Myasthenia Gravis Presenting Solely with Respiratory Failure: A Case Report
Provisionally accepted
- 1Anhui Provincial Hospital, Hefei, China
- 2Suzhou Municipal Hospital, Suzhou, China
- 3The first people's Hospital of Hefei, hefei, China
- 4The Third people's Hospital of Hefei, Hefei, China
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Background: Muscle-specific kinase (MuSK) myasthenia gravis is a rare autoimmune disorder of the neuromuscular junction that predominantly affects the bulbar and respiratory muscles. Although SARS-CoV-2 infection has been implicated as a precipitating factor, post-COVID-19 MuSK-MG remains exceedingly uncommon. Case presentation: A 29-year-old woman with a six-year history of unexplained exertional dyspnoea was hospitalised twice for acute hypercapnic respiratory failure. The first episode, five months earlier, was attributed to severe tricuspid regurgitation; the second occurred eight weeks after mild COVID-19 and was characterized by coma due to hypercapnic respiratory failure without parenchymal lung disease. Diagnosis: Standard electrophysiology, neostigmine testing and acetylcholine-receptor antibodies (AChR-Ab) were negative. Given persistent ventilator dependence, MuSK antibodies (MuSK-Ab) were measured and found strongly positive. Interventions: The patient underwent five plasma-exchange sessions, then received oral prednisone (50 mg day), tacrolimus (1.5 mg q12h) and nebulised salbutamol. Outcomes: She was weaned from non-invasive ventilation by day 23, discharged on day 27 (mMRC grade I) and remained stable on low-dose prednisone/tacrolimus at three-month follow-up. Conclusion: SARS-CoV-2 infection may plausibly act as a trigger for late-onset MuSK-MG presenting as isolated hypercapnic respiratory failure. In otherwise unexplained weaning failure, neuromuscular-junction disease should be considered even without limb or ocular weakness. Early antibody testing and prompt immunomodulatory therapy [plasma exchange (PLEX) plus glucocorticoid/tacrolimus] may be life-saving and yield rapid recovery.
Keywords: MuSK myasthenia gravis, COVID-19, respiratory failure, Tacrolimus, prognosis
Received: 19 Jun 2025; Accepted: 26 Nov 2025.
Copyright: © 2025 Xiaoguang, huang, HUADONG and zhu. 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:
Cao Xiaoguang
jian chong huang
MENG HUADONG
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