COVID-19 vaccine-associated myositis: a comprehensive review of the literature driven by a case report

Abstract

Several cases of vaccine-associated manifestations have been published including cases of inflammatory myositis. Herein, we comprehensively review the literature on the occasion of case of a woman with inflammatory myositis following COVID-19 vaccination. A 67-year-old woman presented with left arm edema, rash, and weakness after the 2nd dose of the BTN162b2 vaccine. Raised muscle enzymes and inflammatory markers with muscle edema on MRI and myositis findings on the electromyogram established the diagnosis. She was successfully treated with methylprednisolone pulses, intravenous immunoglobulin, methotrexate, and hydroxychloroquine. Cases of inflammatory myositis, dermatomyositis, or interstitial lung disease with myositis-specific autoantibodies or myositis-associated autoantibodies within 12 weeks from SARS-CoV-2 vaccination were included. Cases with malignancy, prior or subsequent COVID-19 infection, preexisting myositis/interstitial lung disease (ILD)/dermatomyositis (DM), or other connective tissue diseases were excluded. From our search, 49 cases were identified (mean age: 56.55 + 17.17 years), 59% were women, while 12 patients received the ChAdOx1 vaccine, 27 the BNT162b2, 8 the mRNA-1273, 1 the DB15806, and 1 the Ad26.COV2.S (overall, 70% received mRNA vaccines). Muscle involvement was the most common manifestation (79.5%), followed by skin involvement (53%) and ILD (34.6%), which were more common in the m-RNA vaccinees. Muscle biopsy, MRI findings, and autoantibody profile varied significantly, while successful immunosuppressive treatment was applied in most cases. Inflammatory myositis after COVID-19 vaccination has been well documented worldwide. Current evidence in support of a pathogenic link is challenging due to significant variation in clinical manifestations, radiological, histopathological, and immunological features.

MDA5-autoimmunity and interstitial pneumonitis contemporaneous with the COVID-19 pandemic (MIP-C)

“…Such an acronym has credence because of the distinct features that separate MIP-C from the syndrome of adult MDA5+ DM 57 including our population being predominantly Caucasian instead of the historically reported MDA5 + -DM East Asian predilection and the lower rate of ILD that was evident in 42% of cases, at least thus far, to that historically reported in MDA5 + -DM. 58 , 59 , 60 Also the pathogenesis of MDA5 + -DM is poorly understood but our work in 60 new cases and that from around the world 2 , 3 , 4 , 5 , 19 , 21 , 25 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 shows good evidence for a link to SARS-CoV-2 infection and vaccination and possibly both ( Fig. 2 ).…”

Characteristics of emerging new autoimmune diseases after COVID‐19 vaccination: A sub‐study by the COVAD group

“…Seventy percent of vaccine‐associated IIM occurred following an mRNA vaccine, according to one systematic review. This could be attributed to higher vaccination rates with mRNA vaccines globally 16–19 . Although the exact mechanism underlying vaccine‐induced IIM is not clear, it is noteworthy that COVID‐19 vaccination and infection have been associated with the development of myositis‐specific autoantibodies, particularly anti‐melanoma differentiation‐associated gene 5 (MDA‐5) antibodies 20 .…”

“…This could be attributed to higher vaccination rates with mRNA vaccines globally. [16][17][18][19] Although the exact mechanism underlying vaccine-induced IIM is not clear, it is noteworthy that COVID-19 vaccination and infection have been associated with the development of myositis-specific autoantibodies, particularly anti-melanoma differentiation-associated gene 5 (MDA-5) antibodies. 20 However, these links remain tenuous and further warrant extensive research.…”

Risk factors associated with COVID‐19 pneumonia in Chinese patients with pre‐existing interstitial lung disease during the SARS‐CoV‐2 pandemic

“…However, the COVID-19 vaccine does have several adverse events, 30 including CTD, sarcoidosis, and AE-ILD after vaccination. [15][16][17]31,32 physicians are concerned about the safety of vaccines, so they refused vaccination for COVID-19. In our study, 275 (52.4%) patients were never vaccinated, and seventeen patients were only vaccinated once.…”

“…and severe fibrosing ILD. [13][14][15][16][17] The characteristics of COVID-19 pneumonia in patients with A total of 662 patients with ILD visited our ILD clinic during the enrollment period. Among them, 107 patients were diagnosed with ILD for the first time.…”