ANTI-MDA5 DERMATOMYOSITIS after BNT162B2 VACCINATION

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.