Covid-19 Vaccine-Induced Myositis
Rheumatology (United Kingdom)
; 62(Supplement 2):ii135-ii136, 2023.
Article
in English
| EMBASE | ID: covidwho-2326665
ABSTRACT
Background/Aims Through the COVID pandemic there have emerged reports of autoimmunity or new rheumatic diseases presenting in patients after they had COVID-19. This is thought to be caused by cross-reactivity of the COVID-19 spike protein to human antigens. Given the use of mRNA COVID-19 vaccinations which express the spike protein we might expect to see presentation of new rheumatic diseases following their use. We discuss a case where this appears to have occurred. Methods Our patient is a 24-year-old male with mixed phenotype acute leukaemia who had been treated with allogenic stem cell transplant and was currently in remission. He presented with fevers, palpitations, myalgia and bilateral arm and leg swelling. Symptoms began the day after receiving the first dose of an mRNA COVID-19 vaccination (Pfizer/BioNTech.) There were no other symptoms or recent change in medications. Physical examination revealed tender oedema in his forearms, biceps and thighs bilaterally with sparring of the hands. He had reduced power with shoulder (MRC 3/5), elbow (4), wrist (4+) and hip (4) movements. Observations revealed tachycardia and fevers up to 40C. Results Laboratory studies showed markedly elevated C-reactive protein (202), creatinine kinase (6697) and troponin (593) whilst investigations for infection were negative. An autoimmune panel was positive for anti- PM-SCL-75-Ab. An electrocardiogram showed sinus tachycardia. Echocardiogram was normal. Bilateral upper limb dopplers revealed no deep vein thrombus. An MRI of his thighs showed diffuse symmetrical oedema within the muscles, in keeping with an inflammatory myositis. A quadricep muscle biopsy showed evidence of MHC class 1 up-regulation, suggesting an inflammatory process. In addition, there were numerous macrophages evident in the endomysium. While this can be seen in graft-versus-host disease (GVHD), they would usually be found in the perimysium. After discussion between haematology, rheumatology and neurology, this was felt to be a case of vaccine induced myositis and myocarditis. Autoimmune myositis was thought to be less likely due to the relative sparing of the hands and the absence of Raynaud's phenomenon. 1 gram of intravenous methylprednisolone was then given for 3 days. The patient had a marked response with defervescence, improving laboratory markers, improved myalgia and decreased limb swelling. The patient was stepped down to a reducing regime of prednisolone and discharged. Due to relapse whilst weaning he has started on mycophenalate mofetil and rituximab and now continues to improve. Conclusion There are case reports of myositis following COVID-19 vaccination but our patient's case is complicated by the differential diagnosis of GVHD and concurrent myocarditis. Ongoing work is needed to clarify the exact link between vaccination and the presentation of a new inflammatory myositis, but it is important to recognise and start treatment early in order to preserve muscle bulk and ensure recovery.
acute leukemia; adult; adverse drug reaction; arm swelling; autoimmune myopathy; biceps brachii muscle; cancer patient; cancer recurrence; case report; clinical article; conference abstract; coronavirus disease 2019; deep vein thrombosis; diagnosis; differential diagnosis; echocardiography; edema; elbow; electrocardiogram; electrocardiography; endomysium; fever; forearm; graft versus host reaction; heart palpitation; hematology; hip; human; human cell; inflammation; intravenous drug administration; leg swelling; limb swelling; macrophage; male; muscle biopsy; muscle mass; myalgia; myocarditis; myositis; neurology; nuclear magnetic resonance imaging; perimysium; phenotype; physical examination; Raynaud phenomenon; remission; rheumatology; shoulder; side effect; sinus tachycardia; stem cell; surgery; tachycardia; thigh; upper limb; upregulation; vaccination; weaning; wrist; young adult; C reactive protein; creatine kinase; endogenous compound; major histocompatibility antigen class 1; messenger RNA; methylprednisolone; prednisolone; rituximab; SARS-CoV-2 vaccine; troponin
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Diagnostic study
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Topics:
Vaccines
Language:
English
Journal:
Rheumatology (United Kingdom)
Year:
2023
Document Type:
Article
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