key: cord-0798737-ed78mosx
authors: Wu, Marlyn; Karim, Maria; Ashinoff, Robin
title: COVID-19 Vaccine Associated Dermatomyositis
date: 2022-03-02
journal: JAAD Case Rep
DOI: 10.1016/j.jdcr.2022.02.023
sha: fd01d97318eacc7983622f59a521d7eea601e201
doc_id: 798737
cord_uid: ed78mosx

nan

of one dose of the Pfizer-BioNTech Covid-19 messenger RNA vaccine. 7

Case 8

A 77-year-old Hispanic female with no prior dermatologic or medical history presented with 9 generalized muscle aches and weakness, fever, and a moderately pruritic and painful eruption. 10

The eruption was first noted on the upper right arm, which subsequently progressed to the left 11 arm, chest, and neck. She had received an initial dose of the Covid-19 vaccine 5 days prior to the 12 onset of these symptoms. On physical examination, violaceous, poikilodermatous scaly plaques 13 on the anterior neck and chest were appreciated ( Interestingly, dermatomyositis has not been historically associated with increasing incidence 51 after large vaccination campaigns. 6 There are very few overall reported cases of vaccine-52 associated dermatomyositis in the medical literature. Cases of dermatomyositis occurring after 53 vaccination for bacillus Calmette-Guérin (BCG), influenza, tetanus, and hepatitis B virus have 54 been sporadically reported, though an increase in dermatomyositis incidence has not been 55 associated with mass vaccination efforts. 7-9 56

Vaccination may induce the development of dermatomyositis through robust immune 57 system activation, resulting in immune disturbances and dysregulation, manifesting as 58 autoimmune disease. 10 The development of autoimmune conditions including Kawasaki disease, 59 autoimmune myositis, and dermatomyositis following Covid-19 infection itself have been 60 sporadically reported. 11 The mechanism of autoimmune conditions developing after vaccination 61 is thought to be analogous to those occurring after natural infections. 3 The mechanism is thus 62 thought to involve molecular mimicry, epitope spreading, bystander activation, release of cryptic 63 epitopes, reactivation of memory T cells, activation of superantigens, or direct inflammatory 64 damage resulting in the release of autoantigens. 3 The identification of 3 immunogenic epitopes in 65 patients with dermatomyositis with high sequence identity to SARS-CoV-2 proteins suggests an 66 overlapping mechanism of immune pathogenesis. 12 These immunogenic epitopes with high 67 sequence identity also serve as targets for vaccine development. Adjuvant incorporation into 68 vaccine formulations serve as an immune stimulus which increases antigen recognition, T cell 69 vaccination with one of these vaccines is likely a factor of the vaccine itself. 74

Our patient had no prior history of dermatomyositis or underlying malignancy and was 75 not exposed to other environmental triggers or medications that may have precipitated the onset 76 of the disease. Therefore, we believe that vaccination with the Covid-19 messenger RNA vaccine 77 contributed to the development of her dermatomyositis. We present this case to inform 78 dermatologists of this possible association, and to highlight the importance of obtaining a 79 vaccination history in a patient with findings suggestive of an inflammatory myopathy. 

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