Immune-mediated necrotizing myopathy (NAM) related to SARS-Cov-2 infection: a case report

Abstract

Background There is a growing body of evidence that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) or COVID-19 infection is associated with the development of autoimmune diseases. A recent systematic review reported that the new-onset autoimmune disorders during or after COVID-19 infection included inflammatory myopathies such as immune-mediated necrotizing myopathies. Case presentation We described a 60-year-old man diagnosed with COVID-19 infection and later presented with a two-week history of myalgia, progressive limb weakness, and dysphagia. He had a Creatinine Kinase (CK) level of more than 10,000 U/L, was strongly positive for anti-signal recognition particle (SRP) and anti-Ro52 antibody, and a muscle biopsy revealed a paucity-inflammation necrotizing myopathy with randomly distributed necrotic fibers, which was consistent with necrotizing autoimmune myositis (NAM). He responded well clinically and biochemically to intravenous immunoglobulin, steroids and immunosuppressant and he was able to resume to his baseline. Conclusion SARS-CoV-2 may be associated with late-onset necrotizing myositis, mimicking autoimmune inflammatory myositis.

Anti-SRP immune-mediated necrotizing myopathy responsive to ofatumumab: a case report

“…Our patient experienced a significant worsening of clinical symptoms following the COVID-19 infection. Several case reports have been published regarding IMNM associated with COVID-19 infections (4)(5)(6). These reports highlighted the potential connection between infections and the exacerbation of IMNM symptoms.…”