A 48-year-old gentleman, diagnosed as anti-MuSK-positive MG at another center, was on treatment with steroids and pyridostigmine. He presented to our emergency services with shortness of breath. Five cycles of plasma exchange followed by a course of IVIG were given without improvement. He was then given IV rituximab (375 mg/m2 weekly for 4 weeks) and he had complete resolution of symptoms. Steroids were tapered and stopped. He is in remission for the past 1½ year and is on intermittent pulses of rituximab.
A 58-year-old female presented with a 1-month history of bulbar symptoms in the form of difficulty in swallowing and speaking. Anti-MuSK antibodies were positive. CECT of the chest was normal. She was treated with five cycles of plasma exchange followed by IVIG. She had persistent bulbar weakness after 1 month of the above treatment, so she was administered IV rituximab. She improved remarkably, with almost complete resolution of her bulbar and other symptoms. She is doing well at 8-month follow-up.