ABSTRACT
Background: The anti-SARS2 vaccination is considered the best way to reduce the frequency and the subsequent effects of COVID19 pandemic. To this aim, the most used in western countries are mRNA vaccines BNT16162b2 (Pfzer-Bi-oNT) and mRNA-1273 (Moderna). With both these vaccines the risk/benefts balance is largely favorable and severe adverse effects are almost rare. In keeping, although transient myalgia and arthralgia are frequently seen, myositis have been until now rarely reported. Objectives: To report two cases of myositis occurring in two patients after BNT16162b2 vaccine administration evaluated at the Center for Rheumatic Diseases in Venice, Italy. Methods: In these patients clinical examination, blood and instrumental investigations for myositis and, in addition HLA typing, were performed. Patients were followed for at least six months after the onset of symptoms. Results: The frst patient, a 54-year-old male, complained of high-grade fever 4 days after the I dose of BNT16162b2 (Pfzer-BioNT) followed, by mild fatigue, muscle soreness and increasing weakness. He was sent to the emergency department of the local Hospital. The physical examination confrmed the muscle weakness. Blood investigation revealed an increase of AST: 509 U/L (NV< 37), ALT:189 U/L (NV <78), LDH 609, CPK 11394 U/L (NV<, 309), Myoglobin 3571 ng/ml (VN <96), CRP 1. 6 mg/dl. Prednisone (PN) was started (50 mg orally day) and tapered to 5 mg in two weeks. At high doses, the symptoms slightly improved, but when < 10 mg, all the symptoms reappeared. Thus, he was hospitalized again. The new examination confrmed the increase of all indices of myositis;antinuclear antibodies and myositis antibodies were absent and PN was restarted at 10 mg/day without beneft;echo-cardiography and TC scan were negative. He was then sent to our observation. We increased the dose of PN at 1 mg/PN/kg and we required HLA typing. Two weeks later symptoms disappared almost completely and then we tapered PN 5 mg/day weekly. At present the patients is completely well and muscle indices negative since two months. HLA typing revealed the presence of B∗35 and DRB1∗15. The second case was a 29-year-old female presented with a history of complaints appeared two days after the vaccination with BNT16162b2 administration (Pfzer-BioNT) characterized by three days of high-degree fever, followed by sever weakness, especially in the arms. The family doctor decide to hear our advise. At the initial presentation arm strenght was very decrease and the patient was accompanied. We required a serie of investigations which revealed: CPK 8950 U/L (NV 250), CRP 3.5 mg/dl increased;antinuclear and anti-myositis antibodies absent;cardiac (Ultrasound) and thoracic (CT) investigation and electro-myography negative. HLA typing revealed the presence of haplotypes B∗35 and DRB1∗15. PN (50 mg orally day) was started;two weeks later she improved and both muscle indices and CRP negative. Thus, we reduce the dosage at 25 mg/day with tapering 5 mg weekly. She was completely remitted at end of PN cycle. At present, three month later she is well. Conclusion: The rare occurrence of some particular side effects is not predictable. Our cases of severe myositis which in both cases completely remitted in some months are associated with haplotypes HLA-B∗35 and DRB1∗15. These are both binding sites linked to high-affinity interactions to S-protein T-cell epitope which account for high potentials to trigger immunogenic responses to the S protein of SARS-CoV-2 (1). Furthermore classically, HLA-B35 is associated with reactive arthritis and self-limiting, unclassifed rheumatism (2).
ABSTRACT
Background: Background: Anti-Melanoma Differentiation-Associated gene 5 (MDA-5) Dermatomyositis (MDA5, DM) is a rare systemic autoimmune disease, characteristically associated with Rapidly Progressive Interstitial Lung Disease (RP-ILD) and cutaneous manifestations. Anti-MDA5 dermatomyositis may develop in genetically predisposed subjects after environmental exposure such as vaccines, infections and neoplasms (1). Myalgia is one of the main symptoms related to SARS-COV2 infection and sometimes may occurs after COVID-19 vaccine administration (2). However, only few cases have reported the occurrence of severe infammatory myopathies after COVID19 vaccine administration (3) Objectives: To describe a case of Anti-MDA5 Dermatomyositis occurred after BNT162b2 vaccine administration Methods: This is a case of a 44 year-old-patient affected by Anti-MDA5 Dermat-omyositis occurred after BNT162b2 vaccination referred at the Center for Rheumatic Diseases in Venice, Italy Results: A 44 year-old-woman presented to the Center for Rheumatic Diseases in Venice, suffering from a cutaneus rash on her face, upper limbs, décolleté, gluteus and lower limbs occurred two days after the frst dose BNT162b2 vaccination (Figure 1). A few days after the second dose of the vaccine the rash got worse and myalgias, strength defciency and fatigue occurred. Elevated infam-matory and myocytolysis parameters were detected (Table 1). After chest HRCT a mild ILD was diagnosed. Muscle edema was detected with whole-body short tau inversion recovery (STIR)-MRI (Figure 1).The Skyn biopsy showed features of dermatomyositis with perivascular infammatory infltrates. 1 mg/Kg/die of prednisone was administered and then cyclosporine 3mg/kg/die was associated with clinical beneft. Conclusion: In rare cases COVID-19 vaccination could induce infammatory myopathies (3). COVID-19 vaccine administration may have acted as a trigger for the myopathy driven by an autoimmune-mechanism. In such cases, it could be useful to investigate infammatory myopathies, requiring blood tests (e.g. myo-cytolysis indices and anti myositis antibodies) and medical instrumental insights, in patients affected by skin manifestation and muscle pain occurred after vaccine administration. Although the association between vaccination and infammatory myopathies is presumptive, the temporal proximity of the BNT162b2 vaccine to the onset of the signs and symptoms related to the infammatory miopathies may suggest a possible relationship between these two events. To the best of our knowledge this is the frst case of Anti-MDA5 Dermatomyositis occurred after BNT162b2 vaccination.
ABSTRACT
BACKGROUND: Whether patients with autoimmune rheumatic diseases (ARD) have a higher risk for SARS-CoV-2 infection (COVID-19) and how SARS-CoV-2 pandemic impacts on adherence to therapy has not been fully elucidated. We assessed the rate and clinical presentation of COVID-19, and adherence to therapy in a large cohort of patients with ARD followed-up in a tertiary University-Hospital in Northeast Italy. METHODS: Between April 9th and April 25th, 2020, after SARS-CoV-2 infection peak, a telephone survey investigating the impact of COVID-19 on patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), ANCA-associated vasculitis (AAV), and idiopathic inflammatory myopathies (IIM) was administered. Demographics, disease activity status, therapy, occupational exposure, and adherence to social distancing advise were also collected. RESULTS: 916 patients (397 SLE, 182 AAV, 176 SSc, 111 RA, 50 IIM) completed the survey. 148 patients developed at least one symptom compatible with COVID-19 (cough 96, sore throat 64, fever 64, arthromyalgias 59, diarrhea 26, conjunctivitis 18, ageusia/hyposmia, 18). Among the 916 patients, 65 (7.1%) underwent SARS-CoV-2 nasopharyngeal swab (18 symptomatic and 47 asymptomatic), 2 (0.21%) tested positive, a proportion similar to that observed in the general population of the Veneto region. No deaths occurred. 31 patients (3.4%) withdrew ≥1 medication, mainly immunosuppressants or biologics. Adoption of social distancing was observed by 860 patients (93.9%), including 335 (36.6%) who adopted it before official lockdown. CONCLUSIONS: COVID-19 incidence seems to be similar in our cohort compared to the general population. Adherence to therapy and to social distancing advise was high.