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 49-year-old lady with MuSK-positive MG, diagnosed outside and treated with steroids, presented with fever, cough, and breathlessness for 2 weeks. Keeping a possibility of community-acquired pneumonia, she was managed with IV antibiotics with which her fever improved, but her dyspnea continued. Myasthenia crisis was considered, and a cycle of IVIG (2 g/kg) followed by IV cyclophosphamide was given with mild improvement. She was continuing monthly IV cyclophosphamide but never attained remission. She was then started on IV rituximab (375 mg/m2 weekly for 4 weeks), to which she responded remarkably with complete resolution of respiratory difficulty and other symptoms.