J Korean Med Sci.  2022 Feb;37(5):e32. 10.3346/jkms.2022.37.e32.

Dermatomyositis Following BNT162b2 mRNA COVID-19 Vaccination

• Gouda W
• Albasri A
• Alsaqabi F
• Al Sabah HY
• Alkandari M
• Abdelnaby H

• KMID: 2525484
• DOI: http://doi.org/10.3346/jkms.2022.37.e32

Abstract

Dermatomyositis (DM) is one of the uncommon multi-organ idiopathic inflammatory myopathies that has been reported following the hepatitis B, Influenza, tetanus toxoid, H1N1, and BCG vaccines. However, an association with the coronavirus disease 2019 (COVID-19) vaccine is yet to be reported. In this case, we present the case of a 43-year-old Asian Indian female who was diagnosed with DM 10 days after receiving the second dosage of BNT162b2 mRNA COVID-19 vaccination, in the absence of any additional triggering factors. The diagnosis was established based on physical examination, serological antibodies, magnetic resonance imaging of the muscles, skin biopsy, and electromyography. She received standard treatment for DM, including oral high doses of prednisolone, hydroxychloroquine, mycophenolate, and physiotherapy. The treatment successfully reversed skin changes and muscle weakness. This is the first reported case of classic DM complicated by interstitial lung disease following COVID-19 vaccination. More clinical and functional studies are needed to elucidate this association. Clinicians should be aware of this unexpected adverse event following COVID-19 vaccination and arrange for appropriate management.

Keyword

Dermatomyositis; Myositis; Myopathy; Creatinine Phosphokinase; COVID-19; Vaccination; mRNA Vaccines; Adverse Event Following Immunization

Figure

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  Fig. 1 Dermatological changes seen in this patient’s face, chest, and back (including a pruritic rash, along with V-shaped rashes on her neckline). Published under informed consent of the patient.

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  Fig. 2 Skin biopsy with hematoxylin-eosin and immunofluorescence staining. (A) An atrophic epidermis with flattened ridges (arrows) and a marked vacuolar interface with pigment incontinence (arrowhead). (B) There is a superficial and deep perivascular infiltrate predominantly of lymphocytes with increased amounts of connective-tissue mucin, which is consistent with DM (black arrowhead).

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  Fig. 3 Magnetic resonance imaging of the thigh muscles shows areas of myositis (arrows).

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  Fig. 4 High-resolution computed tomography imaging of the chest shows bilateral basal thick fibrotic bands with patchy ground-glass opacification, consistent with early interstitial lung disease.

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