Successful Control of Myasthenic Crisis After the Introduction of Ravulizumab in Myasthenia Gravis: A Case Report

This case study describes the successful use of ravulizumab in treating a 71-year-old woman with myasthenia gravis experiencing a myasthenic crisis. The patient initially presented with hypernasality and dysphagia; her medical history included untreated, complicated type 1 diabetes. The patient received several treatments approved in Japan for general myasthenia gravis, including immunoadsorption plasmapheresis, tacrolimus, intravenous immunoglobulin, and intravenous methylprednisolone. Despite these treatments, the patient's condition fluctuated, and she ultimately experienced a myasthenic crisis, which required ventilator management. The introduction of ravulizumab, a complement inhibitor targeting the complement protein C5, marked a significant turning point in the patient's treatment. Ravulizumab improved the patient's respiratory function, allowing ventilator weaning and discharge from the hospital. To the best of our knowledge, this case is the first report of successful weaning from mechanical ventilation after treatment with ravulizumab in a patient with a myasthenic crisis. This finding suggests the efficacy of ravulizumab in the management of refractory myasthenia gravis and highlights the potential of novel therapeutic approaches and combination strategies in improving the condition. Future clinical trials are needed to assess the efficacy and safety of ravulizumab in larger, more diverse populations of patients with myasthenia gravis.