BACKGROUNDCardiac involvement in Takayasu's arteritis (TA), a large vessel vasculitis (LLV) that affects patients at a young age, is an important cause of morbidity and mortality. Cardiac manifestations include hypertension and involvement of the cardiac valves, myocardium and coronary arteries. However, inflammatory cardiomyopathy (cardiac dysfunction as a consequence of myocarditis), is rarely reported. Therefore, we reported a case of dilated cardiomyopathy secondary to myocarditis at disease onset of TA.
BACKGROUNDDue to COVID-19 pandemic, cases of autoimmune myopathies or myositis induced by SARS-CoV-2 infection have been reported. However, to date, there have been no reports of immune-mediated necrotizing myopathy (IMMN) induced by COVID-19.
CASE REPORTA 34-year-old woman who developed mild flu-like symptoms and tested positive for SARS-CoV-2 infection (nasopharyngeal swabs, RT-PCR method) in October 2020. However, a posteriori, the patient was evaluated with myalgia and progressive and muscle weakness predominantly in the proximal limb muscles (manual muscle testing [MMT]: 8:57 out of 80), without skin lesions, dysphagia, dyspnea, or another commemorative. Magnetic resonance imaging of the thigh muscle revealed a diffuse and extensive edema area. Laboratory data showed high serum creatine phosphokinase levels (1,316 U/L; reference < 190 U/L), negative antinuclear factor and anti-SRP, and negative viral serologies. Vastus lateralis muscle biopsy showed an area of intense myofiber necrosis with macrophages and an absence of lymphomononuclear infiltrates. With the hypothesis of MNIM, the patient received two methylprednisolone pulse therapies (1 g/day for 5 days, interval of 1 month) with prednisone (1 mg/kg/day) and methotrexate (maximum of 15 mg/week). The patient showed significant improvement in clinical and laboratory data. Prednisone was stopped after 2 months. After 1 year, the patient was stable without muscle weakness and a serum creatine phosphokinase level of 94 U/L.
CONCLUSIONTo the best of our knowledge, this is the first report of a IMMN case induced by COVID-19 and with a favorable outcome and good response to glucocorticoid and immunosuppressive therapy.
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