Dermatomyositis (DM) is a rare systemic autoimmune disease characterized
by symmetrical and predominantly proximal muscle weakness in the limbs,
associated with typical skin lesions. Autoimmune diseases have already been
described as an adverse effect of vaccines. Case-report: A 65-year-old
Caucasian female patient evolved, 5 days after the first dose of the AZD1222
vaccine against the COVID-19 virus, with skin lesions suggesting heliotrope and
Gottron’s sign, with partial improvement of the condition with use of topical glucocorticoids in the lesions. After two months,
the patient received the second dose of AZD1222 vaccine, and evolved with
proximal muscle weakness of upper and lower limbs, dysphagia, increase
of muscle enzymes, in addition to skin lesions compatible with heliotrope and
Gottron’s sign again. After treatment with pulse therapy with
methylprednisolone 1000mg per day for three days and treatment with immunosuppressants, she
evolved with significant clinical improvement. Conclusions: This case-report
demonstrating an important chronological relationship between dermatomyositis and the vaccine AZD1222 alerts to the possibility
of the disease as an important adverse reaction of vaccine against
COVID-19 virus, as has been recently described by other authors.
References
[1]
Lundberg, I.E., Tjarnlund, A., Bottai, M., Werth, V.P., Pilkington, C., de Visser, M., et al. (2017) European League against Rheumatism/American College of Rheumatology Classification Criteria for Adult and Juvenile Idiopathic Inflammatory Myopathies and Their Major Subgroups. Arthritis & Rheumatology, 69, 2271-2282. https://doi.org/10.1002/art.40320
[2]
Shervani, Z., Khan, I., Khan, T. and Qazi, U. (2020) COVID-19 Vaccine. Advances in Infectious Diseases, 10, 195-210. https://doi.org/10.4236/aid.2020.103020
Merad, M., Blish, C.A., Sallusto, F. and Iwasaki, A. (2022) The Immunology and Immunopathology of COVID-19. Science, 375, 1122-1127. https://doi.org/10.1126/science.abm8108
[5]
Sharif, N., Alzahrani, K.J., Ahmed, S.N. and Dey, S.K. (2021) Efficacy, Immunogenicity and Safety of COVID-19 Vaccines: A Systematic Review and Meta-Analysis. Frontier Immunology, 12, Article ID: 714170. https://doi.org/10.3389/fimmu.2021.714170
[6]
Medeiros-Ribeiro, A.C., Aikawa, N.E., Saad, C.G.S., Yuki, E.F.N., Pedrosa, T., Fusco, S.R.G., et al. (2021) Immunogenicity and Safety of the CoronaVac Inactivated Vaccine in Patients with Autoimmune Rheumatic Diseases: A Phase 4 Trial. Nature Medicine, 27, 1744-1751. https://doi.org/10.1038/s41591-021-01469-5
[7]
Cohen, S.R., Prussick, L., Kahn, J.S., Gao, D.X., Radfar, A. and Rosmarin, D. (2021) Leukocytoclastic Vasculitis Flare Following the COVID-19 Vaccine. International Journal of Dermatology, 60, 1032-1033. https://doi.org/10.1111/ijd.15623
[8]
Diaz, G.A., Parsons, G.T., Gering, S.K., Meier, A.R., Hutchinson, I. and Robicsek, A. (2021) Myocarditis and Pericarditis after Vaccination for COVID-19. JAMA Journal of the American Medical Association, 326, 1210-1212. https://doi.org/10.1001/jama.2021.13443
[9]
Franchini, M., Liumbruno, G.M. and Pezzo, M. (2021) COVID-19 Vaccine-Associated Immune Thrombosis and Thrombocytopenia (VITT): Diagnostic and Therapeutic Recommendations for a New Syndrome. European Journal of Haematology, 107, 173-180. https://doi.org/10.1111/ejh.13665
[10]
Majid, I. and Mearaj, S. (2021) Sweet Syndrome after Oxford-AstraZeneca COVID-19 Vaccine (AZD1222) in an Elderly Female. Dermatologic Therapy, 34, 1-2. https://doi.org/10.1111/dth.15146
[11]
Tarawneh, O. and Tarawneh, H. (2021) Immune Thrombocytopenia in a 22-Year-Old Post COVID-19 Vaccine. American Journal of Hematology, 96, 133-134. https://doi.org/10.1002/ajh.26106
[12]
Coronel, A.C., Balderas, F.J.J., Quiñones, H.M., Zavala, M.R.H., Rodríguez, P.M., Vázquez, J.R.H., et al. (2022) Dermatomyositis Post Vaccine against SARS-CoV2. BMC Rheumatololy, 6, Article No. 20. https://doi.org/10.1186/s41927-022-00250-6
[13]
Wu, M., Karim, M. and Ashinoff, R. (2022) COVID-19 Vaccine Associated Dermatomyositis. JAAD Case Reports, 23, 58-60. https://doi.org/10.1016/j.jdcr.2022.02.023
[14]
Gouda, W., Albasri, A., Alsaqabi, F., Al Sabah, H.Y., Alkandari, M. and Abdelnaby, H. (2022) Dermatomyositis Following BNT162b2 mRNA COVID-19 Vaccination. Journal Korean Medical Science, 37, e32. https://doi.org/10.3346/jkms.2022.37.e32
[15]
Lee, A.Y.S., Lee, C., Brown, D.A. and Suan, D. (2022) Development of Anti-NXP2 Dermatomyositis Following Comirnaty COVID-19 Vaccination. Postgraduate Medical Journal, 1-2. https://doi.org/10.1136/postgradmedj-2022-141510
[16]
Altman, A., Szyper-Kravitz, M. and Shoenfeld, Y. (2008) HBV Vaccine and Dermatomyositis: Is There an Association? Rheumatology International, 28, 609-612. https://doi.org/10.1007/s00296-007-0485-4
[17]
Jani, F.M., Gray, J.P. and Lanham, J. (1994) Influenza Vaccine and Dermatomyositis. Vaccine, 12, 1484. https://doi.org/10.1016/0264-410X(94)90166-X
[18]
Saud, A., Naveen, R., Aggarwal, R. and Gupta, L. (2021) COVID-19 and Myositis: What We Know So Far. Current Rheumatology Reports, 23, 63. https://doi.org/10.1007/s11926-021-01023-9
[19]
Falsey, A.R., Sobieszczyk, M.E., Hirsch, I., Sproule, S., Robb, M.L., Corey, L., et al. (2021) Phase 3 Safety and Efficacy of AZD1222 (ChAdOx1 nCoV-19) COVID-19 Vaccine. New England Journal Medicine, 16, 2348-2360. https://doi.org/10.1056/NEJMoa2105290
[20]
Dalakas, M.C. (2020) Inflammatory Myopathies: Update on Diagnosis, Pathogenesis and Therapies, and COVID-19-Related Implications. Acta Myologica, 39, 289-301.
[21]
Winkelmann, R.K. (1982) Influenza Vaccine and Dermatomyositis. The Lancet, 320, 495. https://doi.org/10.1016/S0140-6736(82)90520-7
