COVID-19 Cytokine Storm in Myasthenia Gravis Treated with Mesenchymal Stem Cells: The First Philippine Experience

INTRODUCTION: Coronavirus disease 2019 (COVID-19) continues to plague especially the immunocompromised, and yet little is known regarding its treatment on patients who present clinically similar like those with Myasthenia Gravis (MG) in crisis. METHODS: We examined the case of a patient with MG secondary to malignant thymoma who went into COVID-19 cytokine storm and during her recovery, also suffered a postinfectious myasthenic crisis. RESULTS: After 10 days of intubation and completing 4 doses of mesenchymal stem cell therapy (MSc), thepatient significantly improved and was discharged ambulatory with assistance oxygen-requiring on nasal cannula coexistent with a decrease in measured cytokine levels. DISCUSSION: Immunosuppressive treatment, defective immunoregulatory mechanisms, pro-inflammatory state and respiratory muscle weakness in MG has all shown worse outcomes in COVID-19. Both diseases share a common pathomechanism and recovery depends on a healthy T-cell regulatory and B-cell response. MSc, with its immunomodulatory and anti-inflammatory properties, is thus promising in COVID-19 treatment in the setting of autoimmunity.