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Opportunistic infections in myasthenia gravis treated with mycophenolate mofetil

Pichet Termsarasab1, Bashar Katirji

  • 1Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA. Pichet.Termsarasab@uhhospitals.org

Journal of Neuroimmunology
|May 23, 2012
PubMed

Insights

Mycophenolate mofetil (MMF) can cause serious infections like CMV and EBV in myasthenia gravis (MG) patients, particularly the elderly. Prophylactic antiviral measures are recommended for these patients on MMF therapy.

Area of Science:

  • Neurology
  • Immunology
  • Infectious Diseases

Background:

  • Myasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular junctions.
  • Mycophenolate mofetil (MMF) is an immunosuppressant used in managing MG.
  • Limited data exists on MMF-associated infections in MG patients compared to transplant recipients.

Observation:

  • Two elderly, seropositive MG patients developed severe infections while on MMF.
  • One patient experienced cytomegalovirus (CMV) enteritis after 5 months of MMF.
  • Another patient developed Epstein-Barr virus (EBV) encephalitis after 1 year of MMF.

Findings:

  • Chronic MMF therapy in MG patients poses a risk of life-threatening viral infections.
  • Elderly patients with MG on MMF are particularly susceptible to CMV and EBV.
  • These infections can manifest as enteritis (CMV) and encephalitis (EBV).

Implications:

  • Consider viral serology screening for MG patients initiating MMF therapy.
  • Implement prophylactic antiviral regimens for elderly MG patients on chronic MMF.
  • This approach mirrors practices in solid organ transplant recipients to mitigate infection risks.

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