New-onset dermatomyositis following COVID-19: A case report

Abstract

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most of the infected individuals have recovered without complications, but a few patients develop multiple organ involvements. Previous reports suggest an association between COVID-19 and various inflammatory myopathies, in addition to autoimmune diseases. COVID-19 has been known to exacerbate preexisting autoimmune diseases and trigger various autoantibodies and autoimmune disease occurrence. Here we report a case of complicated COVID-19 with anti-synthetase autoantibodies (ASSs) presenting with skin rash, muscle weakness, and interstitial lung disease (ILD) and subsequently diagnosed with dermatomyositis (DM). A 47-year-old Japanese male patient without any previous history of illness, including autoimmune diseases, presented with a high fever, sore throat, and cough. Oropharyngeal swab for SARS-Cov-2 polymerase chain reaction tested positive. He was isolated at home and did not require hospitalization. However, his respiratory symptoms continued, and he was treated with prednisolone (20 mg/day) for 14 days due to the newly developing interstitial shadows over the lower lobes of both lungs. These pulmonary manifestations remitted within a week. He presented with face edema and myalgia 4 weeks later when he was off corticosteroids. Subsequently, he presented with face erythema, V-neck skin rash, low-grade fever, and exertional dyspnea. High-resolution computed tomography of the chest showed ILD. Biochemical analysis revealed creatine kinase and aldolase elevations, in addition to transaminases. Anti-aminoacyl tRNA synthetase (ARS) was detected using an enzyme-linked immunosorbent assay (170.9 U/mL) (MESACUP™ (Medical & Biological Laboratories, Japan), and the tRNA component was identified as anti-PL-7 and anti-Ro-52 antibodies using an immunoblot assay [EUROLINE Myositis Antigens Profile 3 (IgG), Euroimmun, Lübeck,Germany]. The patient was diagnosed with DM, especially anti- synthase antibody syndrome based on the presence of myositis-specific antibodies, clinical features, and pathological findings. The present case suggests that COVID-19 may have contributed to the production of anti-synthetase antibodies (ASAs) and the development of de novo DM. Our case highlights the importance of the assessment of patients who present with inflammatory myopathy post-COVID-19 and appropriate diagnostic work-up, including ASAs, against the clinical features that mimic DM after post-COVID-19.

Post-COVID syndrome is associated with capillary alterations, macrophage infiltration and distinct transcriptomic signatures in skeletal muscles

“…Upper leg MRI also did not reveal signs of myositis, which is consistent with recently published radiological findings (50). However, biopsies were taken almost a year after acute infection and several case reports of biopsy-proven myositis after SARS-CoV-2 have been published (51)(52)(53), and we ourselves histologically diagnosed non-specific myositis in some patients in the subacute aftermath of mild or moderate COVID (Fig. S3F).…”

Increased rates of idiopathic inflammatory myopathies during the COVID-19 pandemic: a single-centre experience

“…Studies regarding SARS-CoV-2-induced IIM are lacking. Review of the literature yields mostly single case reports (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) , with larger case series referring to SARS-CoV-2 vaccines (21,22). Certainly, higher-level evidence is still required to discern whether the incidence of IIM has increased during the pandemic and whether the disease pattern and course have changed.…”

New‐onset primary Sjögren's syndrome following exposure to severe acute respiratory syndrome coronavirus 2: A retrospective cohort study

“…11 The number of case reports describing autoimmune hepatitis, Guillain-Barré syndrome, immunoglobulin A (IgA) nephropathy, rheumatoid arthritis, dermatomyositis, and systemic lupus erythematosus has recently increased, and a multi-institutional collaborative network in the United States has confirmed an association between SARS-CoV-2 infection and increased risk of autoimmune diseases. [12][13][14] However, the clinical autoimmunity-related manifestations of specific diseases after exposure to SARS-CoV-2, especially in potentially susceptible populations, are not comprehensively understood. Since the first detection of SARS-CoV-2, China has adopted a "dynamic zero" epidemic prevention policy to address SARS-CoV-2 mutations based on demographic and epidemiological characteristics.…”