Complication of coronavirus disease 2019 during remission induction therapy against anti-MDA5 antibody-positive dermatomyositis

Kogami, Masahiro; Suzuki, Satoshi; Nanjo, Yuta; Ikeda, Keigo; Tamura, Naoto; Sasaki, Shin‐ichi; Morimoto, Shinji

doi:10.1093/rap/rkaa068

Cited by 6 publications

(3 citation statements)

References 6 publications

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“…[ 12 ] Bonometti et al [ 13 ] reported the first case of systemic lupus erythematosus (SLE) triggered by COVID-19 infection. Kogami et al [ 14 ] reported a case of a patient with interstitial pneumonia developing as a complication of anti-MDA5 antibody-positive DM diagnosed with COVID-19 during remission induction therapy. These indications may have unique clinical manifestations when combined with COVID-19; therefore, increased attention should be paid to the clinical management of such patients.…”

Section: Discussionmentioning

confidence: 99%

Management of dermatomyositis patients amidst the COVID-19 pandemic: Two case reports

et al. 2022

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Rationale: In December 2019, a new epidemic of coronavirus disease 2019 (COVID-19) appeared in Wuhan, Hubei Province, and spread rapidly to other parts of China and worldwide. Although established methods exist for the diagnosis and treatment of COVID-19 infection, the management of dermatomyositis (DM) patients with COVID-19 is unknown.Patient concerns: In this article, we describe case reports of 2 patients with DM. The first case was a 67-year-old patient with DM and infected with COVID-19 who was admitted to Leishenshan Hospital for a 1-month history of fever, cough, and expectoration. The second case was a 51-year-old male patient who was admitted to Leishenshan Hospital due to fever with cough, expectoration and shortness of breath for 1 month.Diagnoses: The first patient was diagnosed with COVID-19 secondary to DM based on repeated SARS-CoV-2 real-time reverse-transcriptase polymerase-chain-reaction (RT-PCR) test, detailed medical history and chest computed tomography; The second patient was diagnosed with interstitial lung disease associated with anti-MDA5 DM based on the results of antirheumatic and anti-inflammatory therapy and the above 3 methods. Interventions and outcomes:The first patient received supportive and empirical treatment, including antiviral treatment, anti-inflammatory treatment, oxygen therapy and prophylactic anticoagulation therapy. The symptoms and laboratory results got improved after the treatments. He was discharged with thrice negative PCR tests for the SARS-CoV-2 virus. The second patient received a comprehensive treatment, including glucocorticoid and plasma exchange; his symptoms were relieved and improved.Lessons: These cases suggest that repeated new pathogenic test results for the coronavirus and a detailed diagnosis of the medical history are important means to distinguish these diseases. Increased attention to the individual characteristics of different cases may allow for more effective diagnosis and treatment. Abbreviations: COVID-19 = coronavirus disease 2019, CT = computed tomography, DM = dermatomyositis, ESR = erythrocyte sedimentation rate, GGO = ground-glass opacity, LMWH = low-molecular weight heparin,RT-PCR = real-time reversetranscriptase polymerase-chain-reaction, SARS-COV-2 = severe acute respiratory syndrome-coronavirus 2.

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Section: Discussionmentioning

confidence: 99%

Management of dermatomyositis patients amidst the COVID-19 pandemic: Two case reports

et al. 2022

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“…Several case reports have shown that anti‐MDA5 DM can occur following COVID‐19 vaccination 15–17 . Another case report depicted the complication of COVID‐19 during remission induction therapy against anti‐MDA5 DM 18 . However, the clinical features of COVID‐19 in patients with anti‐MDA5 DM remain unclear.…”

Section: Introductionmentioning

confidence: 99%

“…[15][16][17] Another case report depicted the complication of COVID-19 during remission induction therapy against anti-MDA5 DM. 18 However, the clinical features of COVID-19 in patients with anti-MDA5 DM remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Clinical and immunological features of COVID‐19 in patients with anti‐MDA5 dermatomyositis during the omicron wave in Chongqing, China

Wu,

Chen,

Zha

et al. 2024

Journal of Medical Virology

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Patients with anti‐melanoma differentiation‐associated gene 5 (anti‐MDA5) dermatomyositis (DM) have a higher risk of coronavirus disease 2019 (COVID‐19) infection. In this longitudinal observational study, we aimed to investigate the clinical and immunological features of these patients after COVID‐19 infection. A total of 73 patients with anti‐MDA5 DM were recruited from the Second Affiliated Hospital of Chongqing Medical University during the Omicron wave epidemic. Clinical data were collected by questionnaire survey and electronic medical records. Blood samples were used to determine the immunity responses. From December 9, 2022 to March 31, 2023, 67 patients were eligible for final analysis; 68.7% of them were infected with COVID‐19. The most common symptoms observed in COVID‐19 were upper respiratory symptoms, most cases were mild or moderate (97.8%). The clinical laboratory indexes were relativity stable in patients after infection (all p > 0.05). Vaccination is not a protective factor against the Omicron infection (odds ratio: 2.69, 95% confidence interval: 0.81–8.93, p = 0.105). Both wildtype (WT) neutralizing antibodies titer and BA.5‐specific immunoglobulin G titer were significantly enhanced after infection (all p < 0.01), which was as high as healthy controls (HCs). The memory B‐cell responses were similar between the patients with anti‐MDA5 DM and HCs (p > 0.05). However, both the WT‐specific CD8+ T cells and CD4+ T cells were reduced in patients with anti‐MDA5 DM (all p < 0.05). In conclusion, patients with anti‐MDA5 DM did not deteriorate the COVID‐19, in turn, COVID‐19 infection did not increase the risk of anti‐MDA5 DM exacerbation. The humoral responses were robust but the cellular responses were weakened after COVID‐19 infection.

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Immunosuppressants

2021

Reactions Weekly

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Covid-19 pneumonia and delayed viral clearance: case reportA 46-year-old woman experienced Covid-19 pneumonia and delayed viral clearance following immunosuppression therapy with cyclophosphamide, methylprednisolone, prednisolone and tacrolimus for interstitial pneumonia secondary to anti-melanoma differentiation-associated gene-5 (MDA5) antibody-positive dermatomyositis (DM) [not all routes and dosages stated].The woman, who had been diagnosed with interstitial pneumonia secondary to anti-MDA5 antibody-positive DM in February 2020, subsequently started receiving remission induction therapy, comprising pulse therapy with methylprednisolone 500 mg/day for 3 days, followed by post-therapy prednisolone 50 mg/day, IV cyclophosphamide pulse therapy and tacrolimus 4 mg/day as triple therapy. Thereafter, the pneumonia improved, and the anti-MDA5 antibody titre decreased. She was discharged after 4 cycles of IV cyclophosphamide (750 mg/dose), and further cycles were scheduled. However, on 23 April 2020, she developed a non-productive cough. She presented to hospital on 6 May 2020. Chest CT scan revealed non-segmental, bilateral diffuse ground-glass opacities. Her oxygen saturation (while on 2L oxygen via nasal cannula) was 96%. Blood tests at admission revealed the following: low lymphocyte count, hypercoagulability and an inflammatory reaction. Her ferritin levels were normal, but fluctuated prior to admission, suggesting a mild increase. Anti-MDA5 antibody titres continued to show an improving trend. On day 2 of admission, PCR tests performed on a nasopharyngeal swab sample confirmed SARS-CoV-2 positivity, leading to the diagnosis of Covid-19.The woman received off-label therapy with inhaled ciclesonide, favipiravir and nafamostat for 14 days. Oxygen supplementation was discontinued on day 5 of admission. Chest CT scan revealed reduced findings of pneumonia on day 16 of admission. Additionally, PCR tests were performed on alternate days, starting on day 16. On day 29, she developed erythematous papules on the limbs and trunk. Antibody tests for cytomegalovirus, Epstein-Barr virus, herpes simplex virus and herpes zoster virus were all found to be negative, suggesting that the eruptions were secondary to Covid-19. The eruptions spontaneously improved, and she was discharged on day 46, after two consecutive PCRs showed negative results. The immunosuppression was thought to have caused delayed viral clearance, given the prolonged hospitalisation course of 1.5 months.

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Complication of coronavirus disease 2019 during remission induction therapy against anti-MDA5 antibody-positive dermatomyositis

Cited by 6 publications

References 6 publications

Management of dermatomyositis patients amidst the COVID-19 pandemic: Two case reports

Management of dermatomyositis patients amidst the COVID-19 pandemic: Two case reports

Clinical and immunological features of COVID‐19 in patients with anti‐MDA5 dermatomyositis during the omicron wave in Chongqing, China

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