COVID-19 IgG-related autoimmune inflammatory necrotizing myositis

Abstract

The COVID-19 pandemic caused by the SARS-CoV-2 virus has affected millions of people around the globe. The most common presentation of COVID-19 is fever and upper and lower respiratory tract infection. Myalgia is fairly common in the prodromal phase of the viral illness which self-resolves. There is very scant literature on autoimmune myositis triggered by COVID-19 infection. We report a case of SARS-CoV-2 infection, who presented with progressive muscle weakness with rhabdomyolysis and necrotizing autoimmune myopathy on muscle biopsy. This case report imposes awareness of musculoskeletal autoimmune processes triggered by COVID-19 which requires clinical suspicion for early diagnosis and initiation of treatment.

Keywords: infections; muscle disease; musculoskeletal and joint disorders; neurology (drugs and medicines).

Figure 1

Images show inflammation of the muscles, kind of asymmetric distribution, mostly posterior and adductor compartment.

Figure 2

(A) MHC class I stain of muscle biopsy where the muscles are not stained at all. (B, C) Muscle biopsy: mildly necrotic muscle bundles with minimal inflammation. MHC, major histocompatibility complex.