case_images: PMC11135074_01
case_images: (a) The therapeutic timeline of the patient and changes of clinical severity of MG in the patient, assessed through QMG score and MG-ADL score (the red arrows represent the day of efgartigimod). (b) Changes of MG-ADL subdomains in the patient, assessed through QMG score and MG-ADL score (the green arrow represents the day of IVIg and the red arrows represent the day of efgartigimod). (c) The changes of serum IgG, IgM, and IgA levels in the patient.. Ig, immunoglobulin; IVIg, intravenous immunoglobulin; MG-ADL, myasthenia gravis-specific activities of daily living scale; MP, methylprednisolone; NIV, noninvasive ventilation; QMG, quantitative myasthenia gravis score; TAC, tacrolimus.
case_images: 10.1177_17562864241254895-fig1.jpg
case_images: PMC11135074_01_10.1177_17562864241254895-fig1.jpg
case_images: fig1-17562864241254895
case_images: The treatment regimens after admission to our hospital and the changes in QMG score, MG-ADL score, and MG-ADL score in different muscle groups were presented in Figure 1. Figures 1(c) and 2. Frequency of T-cell and B-cell subsets was measured by flow cytometry, and serum concentrations of IgG, IgA, and IgM were measured by immunonephelometry. The patient's level of IgG decreased rapidly after being treated with efgartigimod in the first 3 weeks and increased again after the seventh week, which was correlated with the severity of the disease [Figure 1(c)].
case_images: (a-d) The changes of frequency of T-cell subsets in the patient. (e-h) The changes of frequency of B-cell subsets in the patient.
case_images: 10.1177_17562864241254895-fig2.jpg
case_images: PMC11135074_01_10.1177_17562864241254895-fig2.jpg
case_images: fig2-17562864241254895
case_images: Remarkably, we detected a gradual decrease in the total T cells and CD4+ T cells from the second week [Figure 2(a) and (b)]. Besides, the frequency of Treg cells increased in the initial period of rapid improvement, and then decreased with symptoms rebounding, while Treg cells increased again on 6 December [Figure 2(d)]. Gradual decrease of CD19+ B cells from the first week after being treated with efgartigimod was detected in this patient, while CD19+ B cells increased 69 days after the last injection [Figure 2(e)]. Frequency of plasma cells, plasmablasts, and memory B cells fluctuated throughout the course, but on 1 November and 6 December, plasma cells and plasmablasts were still significantly lower than baseline [Figure 2(f)-(h)].