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. 2022 Dec;42(12):2267-2276.
doi: 10.1007/s00296-022-05176-3. Epub 2022 Aug 8.

New-onset dermatomyositis following SARS-CoV-2 infection and vaccination: a case-based review

Marie-Therese Holzer  1   2 , Martin Krusche  3 , Nikolas Ruffer  3   4 , Heinrich Haberstock  4 , Marlene Stephan  4 , Tobias B Huber  3 , Ina Kötter  3   4
Affiliations

New-onset dermatomyositis following SARS-CoV-2 infection and vaccination: a case-based review

Marie-Therese Holzer et al. Rheumatol Int. 2022 Dec.

Abstract

Dermatomyositis is a rare, type I interferon-driven autoimmune disease, which can affect muscle, skin and internal organs (especially the pulmonary system). In 2021, we have noted an increase in new-onset dermatomyositis compared to the years before the SARS-CoV-2 pandemic in our center. We present four cases of new-onset NXP2 and/or MDA5 positive dermatomyositis shortly after SARS-CoV-2 infection or vaccination. Three cases occurred within days after vaccination with Comirnaty and one case after SARS-CoV-2 infection. All patients required intensive immunosuppressive treatment. MDA5 antibodies could be detected in three patients and NXP2 antibodies were found in two patients (one patient was positive for both antibodies). In this case-based systematic review, we further analyze and discuss the literature on SARS-CoV-2 and associated dermatomyositis. In the literature, sixteen reports (with a total of seventeen patients) of new-onset dermatomyositis in association with a SARS-CoV-2 infection or vaccination were identified. Ten cases occurred after infection and seven after vaccination. All vaccination-associated cases were seen in mRNA vaccines. The reported antibodies included for instance MDA5, NXP2, Mi-2 and TIF1γ. The reviewed literature and our cases suggest that SARS-CoV-2 infection and vaccination may be considered as a potential trigger of interferon-pathway. Consequently, this might serve as a stimulus for the production of dermatomyositis-specific autoantibodies like MDA5 and NXP2 which are closely related to viral defense or viral RNA interaction supporting the concept of infection and vaccination associated dermatomyositis.

Keywords: COVID-19; COVID-19 vaccines; Dermatomyositis; SARS-CoV-2.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patients’ images: a Patient 2: facial swelling, heliotrope erythema. b Patient 1: Gottron papules c Patient 2: magnetic resonance imaging scan (T2) showing bilateral active myositis in the adductors and extensors of the thighs
Fig. 2
Fig. 2
Methodology flowchart of systematic literature review. n number
See this image and copyright information in PMC

References

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