Skip to main content
Top
Published in: Journal of Medical Case Reports 1/2022

Open Access 01-12-2022 | Diseases of the neuromuscular synapses and muscles | Case report

Necrotizing autoimmune myositis following coronavirus disease 2019 infection: a case report

Authors: Maryam Loghman, Ehsan Rahmanian, Majid Alikhani, Hiva Saffar, Sara Beikmohamadi Hezaveh, Mohammad Nekooeian, Reza Shahriarirad, Seyedeh Tahereh Faezi

Published in: Journal of Medical Case Reports | Issue 1/2022

Login to get access

Abstract

Background

Severe acute respiratory syndrome coronavirus 2 may be associated with late-onset necrotizing myositis, mimicking autoimmune inflammatory myositis; however, the exact underlying pathogenesis of severe acute respiratory syndrome coronavirus 2-induced myositis is still unclear.

Case Presentation

Herein, we report a rare case of necrotizing autoimmune myositis in a 67-year-old middle eastern male following coronavirus disease 2019 infection, who presented with muscle weakness. The patient had positive anti-NXP2. The diagnosis of necrotizing autoimmune myositis was made according to muscle weakness, increased liver enzymes, electromyography and nerve conduction velocity results, and muscle biopsy. The patient underwent a full malignancy evaluation, which was unremarkable, and was discharged in relatively well condition with a daily dose of 1 mg/kg prednisolone and azathioprine 150 mg (2 mg/kg).

Conclusion

Our report highlights the already known possible protracted sequence of coronavirus disease 2019 infection and the potential for delayed-onset necrotizing myositis.
Literature
1.
go back to reference Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, El Burai FS, Tie Y, Fullerton KE. Coronavirus disease 2019 case surveillance—United States, January 22-May 30, 2020. Morb Mortal Wkly Rep. 2020;69(24):759–65.CrossRef Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, El Burai FS, Tie Y, Fullerton KE. Coronavirus disease 2019 case surveillance—United States, January 22-May 30, 2020. Morb Mortal Wkly Rep. 2020;69(24):759–65.CrossRef
2.
go back to reference Paliwal VK, Garg RK, Gupta A, Tejan N. Neuromuscular presentations in patients with COVID-19. Neurol Sci. 2020;41(11):3039–56.CrossRef Paliwal VK, Garg RK, Gupta A, Tejan N. Neuromuscular presentations in patients with COVID-19. Neurol Sci. 2020;41(11):3039–56.CrossRef
3.
go back to reference Lokineni S, Mortezavi M. Delayed-onset necrotizing myositis following COVID-19 infection. Eur J Case Rep Intern Med. 2021;8(4): 002461. Lokineni S, Mortezavi M. Delayed-onset necrotizing myositis following COVID-19 infection. Eur J Case Rep Intern Med. 2021;8(4): 002461.
4.
go back to reference Dalakas MC. Inflammatory myopathies: update on diagnosis, pathogenesis and therapies, and COVID-19-related implications. Acta Myol. 2020;39(4):289–301. Dalakas MC. Inflammatory myopathies: update on diagnosis, pathogenesis and therapies, and COVID-19-related implications. Acta Myol. 2020;39(4):289–301.
5.
go back to reference Khan NAJ, Khalid S, Ullah S, Malik MU, Makhoul S. Necrotizing autoimmune myopathy: a rare variant of idiopathic inflammatory myopathies. J Investig Med High Impact Case Rep. 2017;5(2):2324709617709031. Khan NAJ, Khalid S, Ullah S, Malik MU, Makhoul S. Necrotizing autoimmune myopathy: a rare variant of idiopathic inflammatory myopathies. J Investig Med High Impact Case Rep. 2017;5(2):2324709617709031.
6.
go back to reference Adler BL, Christopher-Stine L. Triggers of inflammatory myopathy: insights into pathogenesis. Discov Med. 2018;25(136):75–83. Adler BL, Christopher-Stine L. Triggers of inflammatory myopathy: insights into pathogenesis. Discov Med. 2018;25(136):75–83.
7.
go back to reference Hamann PD, Cooper RG, McHugh NJ, Chinoy H. Statin-induced necrotizing myositis–a discrete autoimmune entity within the “statin-induced myopathy spectrum.” Autoimmun Rev. 2013;12(12):1177–81.CrossRef Hamann PD, Cooper RG, McHugh NJ, Chinoy H. Statin-induced necrotizing myositis–a discrete autoimmune entity within the “statin-induced myopathy spectrum.” Autoimmun Rev. 2013;12(12):1177–81.CrossRef
8.
go back to reference Ripolone M, Napoli L, Mantero V, Sciacco M, Zanotti S. Peculiar histological and ultrastructural skeletal muscle alterations in a patient with CMV infection and autoimmune myositis: case evaluation and brief literature review. Acta Myol. 2022;41(1):41–7. Ripolone M, Napoli L, Mantero V, Sciacco M, Zanotti S. Peculiar histological and ultrastructural skeletal muscle alterations in a patient with CMV infection and autoimmune myositis: case evaluation and brief literature review. Acta Myol. 2022;41(1):41–7.
9.
go back to reference Allenbach Y, Keraen J, Bouvier AM, Jooste V, Champtiaux N, Hervier B, Schoindre Y, Rigolet A, Gilardin L, Musset L, et al. High risk of cancer in autoimmune necrotizing myopathies: usefulness of myositis specific antibody. Brain. 2016;139(Pt 8):2131–5.CrossRef Allenbach Y, Keraen J, Bouvier AM, Jooste V, Champtiaux N, Hervier B, Schoindre Y, Rigolet A, Gilardin L, Musset L, et al. High risk of cancer in autoimmune necrotizing myopathies: usefulness of myositis specific antibody. Brain. 2016;139(Pt 8):2131–5.CrossRef
10.
go back to reference Aussy A, Boyer O, Cordel N. Dermatomyositis and immune-mediated necrotizing myopathies: a window on autoimmunity and cancer. Front Immunol. 2017;8:992.CrossRef Aussy A, Boyer O, Cordel N. Dermatomyositis and immune-mediated necrotizing myopathies: a window on autoimmunity and cancer. Front Immunol. 2017;8:992.CrossRef
11.
go back to reference Narayanappa G, Nandeesh BN. Infective myositis. Brain Pathol. 2021;31(3): e12950.CrossRef Narayanappa G, Nandeesh BN. Infective myositis. Brain Pathol. 2021;31(3): e12950.CrossRef
12.
go back to reference Moshfe A, Sarkari B, Arefkhah N, Nikbakht R, Shahriarirad R, Rezaei Z, Jamshidi A, Moradian F. Seroepidemiological study of cystic echinococcosis in nomadic communities in the southwest of Iran: a population-based study. J Immunoassay Immunochem. 2019;40(2):183–92.CrossRef Moshfe A, Sarkari B, Arefkhah N, Nikbakht R, Shahriarirad R, Rezaei Z, Jamshidi A, Moradian F. Seroepidemiological study of cystic echinococcosis in nomadic communities in the southwest of Iran: a population-based study. J Immunoassay Immunochem. 2019;40(2):183–92.CrossRef
13.
go back to reference Shahriarirad R, Erfani A, Eskandarisani M, Rastegarian M, Taghizadeh H, Sarkari B. Human cystic echinococcosis in southwest Iran: a 15-year retrospective epidemiological study of hospitalized cases. Trop Med Health. 2020;48(1):49.CrossRef Shahriarirad R, Erfani A, Eskandarisani M, Rastegarian M, Taghizadeh H, Sarkari B. Human cystic echinococcosis in southwest Iran: a 15-year retrospective epidemiological study of hospitalized cases. Trop Med Health. 2020;48(1):49.CrossRef
14.
go back to reference Parvizi M, Shahriarirad R, Forouhari S, Shahriarirad S, Bradley R, Rousta L. Prevalence of complementary and integrative health use in patients afflicted with COVID-19. Eur J Integr Med. 2021;48:101983–101983.CrossRef Parvizi M, Shahriarirad R, Forouhari S, Shahriarirad S, Bradley R, Rousta L. Prevalence of complementary and integrative health use in patients afflicted with COVID-19. Eur J Integr Med. 2021;48:101983–101983.CrossRef
15.
go back to reference Ranjbar K, Moghadami M, Mirahmadizadeh A, Fallahi MJ, Khaloo V, Shahriarirad R, Erfani A, Khodamoradi Z, Saadi MHG. Methylprednisolone or dexamethasone, which one is superior corticosteroid in the treatment of hospitalized COVID-19 patients: a triple-blinded randomized controlled trial. BMC Infect Dis. 2021;21(1):1–8. Ranjbar K, Moghadami M, Mirahmadizadeh A, Fallahi MJ, Khaloo V, Shahriarirad R, Erfani A, Khodamoradi Z, Saadi MHG. Methylprednisolone or dexamethasone, which one is superior corticosteroid in the treatment of hospitalized COVID-19 patients: a triple-blinded randomized controlled trial. BMC Infect Dis. 2021;21(1):1–8.
16.
go back to reference Shahriarirad R, Khodamoradi Z, Erfani A, Hosseinpour H, Ranjbar K, Emami Y, Mirahmadizadeh A, Lotfi M, Shirazi Yeganeh B, Dorrani Nejad A, et al. Epidemiological and clinical features of 2019 novel coronavirus diseases (COVID-19) in the South of Iran. BMC Infect Dis. 2020;20(1):427.CrossRef Shahriarirad R, Khodamoradi Z, Erfani A, Hosseinpour H, Ranjbar K, Emami Y, Mirahmadizadeh A, Lotfi M, Shirazi Yeganeh B, Dorrani Nejad A, et al. Epidemiological and clinical features of 2019 novel coronavirus diseases (COVID-19) in the South of Iran. BMC Infect Dis. 2020;20(1):427.CrossRef
17.
go back to reference Shafiekhani M, Shahabinezhad F, Niknam T, Tara SA, Haem E, Mardani P, Zare Z, Jafarian S, Mirzad Jahromi K, Arabsheybani S. Evaluation of the therapeutic regimen in COVID-19 in transplant patients: where do immunomodulatory and antivirals stand? Virology Journal. 2021;18(1):1–10.CrossRef Shafiekhani M, Shahabinezhad F, Niknam T, Tara SA, Haem E, Mardani P, Zare Z, Jafarian S, Mirzad Jahromi K, Arabsheybani S. Evaluation of the therapeutic regimen in COVID-19 in transplant patients: where do immunomodulatory and antivirals stand? Virology Journal. 2021;18(1):1–10.CrossRef
18.
go back to reference Sabetian G, Moghadami M, Haghighi LHF, Shahriarirad R, Fallahi MJ, Asmarian N, Moeini YS. COVID-19 infection among healthcare workers: a cross-sectional study in southwest Iran. Virology journal. 2021;18(1):1–8.CrossRef Sabetian G, Moghadami M, Haghighi LHF, Shahriarirad R, Fallahi MJ, Asmarian N, Moeini YS. COVID-19 infection among healthcare workers: a cross-sectional study in southwest Iran. Virology journal. 2021;18(1):1–8.CrossRef
19.
go back to reference Sabetian G, Shahriarirad S, Moghadami M, Asmarian N, Shahriarirad R, Askarian M, Haghighi LHF, Javadi P: High Post-infection protection after COVID-19 Among healthcare workers: a population-level observational study regarding SARS-CoV-2 reinfection, reactivation, and re-positivity and its severity. 2021. Sabetian G, Shahriarirad S, Moghadami M, Asmarian N, Shahriarirad R, Askarian M, Haghighi LHF, Javadi P: High Post-infection protection after COVID-19 Among healthcare workers: a population-level observational study regarding SARS-CoV-2 reinfection, reactivation, and re-positivity and its severity. 2021.
22.
go back to reference Shahriarirad R, Sarkari B. COVID-19: clinical or laboratory diagnosis? A matter of debate. Trop Doct. 2021;51(1):131–2.CrossRef Shahriarirad R, Sarkari B. COVID-19: clinical or laboratory diagnosis? A matter of debate. Trop Doct. 2021;51(1):131–2.CrossRef
23.
go back to reference Abbasi R, Javanmardi FS, Mokhtari A, Hosseinpour P, Shahriarirad R, Ebrahimi K. Management of pleural empyema in a 12-year-old obese patient with COVID-19: a pediatric case report. BMC Pediatr. 2021;21(1):531.CrossRef Abbasi R, Javanmardi FS, Mokhtari A, Hosseinpour P, Shahriarirad R, Ebrahimi K. Management of pleural empyema in a 12-year-old obese patient with COVID-19: a pediatric case report. BMC Pediatr. 2021;21(1):531.CrossRef
24.
go back to reference Dashti AS, Ebrahimi K, Shahriarirad R, Ghotbabadi SH, Aminnia S: COVID-19 pandemic in the disguise of multi system inflammatory syndrome in children: a case series. 2021. Dashti AS, Ebrahimi K, Shahriarirad R, Ghotbabadi SH, Aminnia S: COVID-19 pandemic in the disguise of multi system inflammatory syndrome in children: a case series. 2021.
26.
go back to reference Veyseh M, Koyoda S, Ayesha B. COVID-19 IgG-related autoimmune inflammatory necrotizing myositis. BMJ Case Rep. 2021;14(4): e239457. CrossRef Veyseh M, Koyoda S, Ayesha B. COVID-19 IgG-related autoimmune inflammatory necrotizing myositis. BMJ Case Rep. 2021;14(4): e239457. CrossRef
27.
go back to reference Mirahmadizadeh A, Ranjbar K, Shahriarirad R, Erfani A, Ghaem H, Jafari K, Rahimi T. Evaluation of students’ attitude and emotions towards the sudden closure of schools during the COVID-19 pandemic: a cross-sectional study. BMC Psychol. 2020;8(1):134.CrossRef Mirahmadizadeh A, Ranjbar K, Shahriarirad R, Erfani A, Ghaem H, Jafari K, Rahimi T. Evaluation of students’ attitude and emotions towards the sudden closure of schools during the COVID-19 pandemic: a cross-sectional study. BMC Psychol. 2020;8(1):134.CrossRef
28.
go back to reference Parvar SY, Ghamari N, Pezeshkian F, Shahriarirad R. Prevalence of anxiety, depression, stress, and perceived stress and their relation with resilience during the COVID-19 pandemic, a cross-sectional study. Health Sci Rep. 2022;5(1): e460.CrossRef Parvar SY, Ghamari N, Pezeshkian F, Shahriarirad R. Prevalence of anxiety, depression, stress, and perceived stress and their relation with resilience during the COVID-19 pandemic, a cross-sectional study. Health Sci Rep. 2022;5(1): e460.CrossRef
29.
go back to reference Ranjbar K, Hosseinpour H, Shahriarirad R, Ghaem H, Jafari K, Rahimi T, Mirahmadizadeh A, Hosseinpour P. Students’ attitude and sleep pattern during school closure following COVID-19 pandemic quarantine: a web-based survey in south of Iran. Environ Health Prev Med. 2021;26(1):33.CrossRef Ranjbar K, Hosseinpour H, Shahriarirad R, Ghaem H, Jafari K, Rahimi T, Mirahmadizadeh A, Hosseinpour P. Students’ attitude and sleep pattern during school closure following COVID-19 pandemic quarantine: a web-based survey in south of Iran. Environ Health Prev Med. 2021;26(1):33.CrossRef
30.
go back to reference Shahriarirad R, Erfani A, Ranjbar K, Bazrafshan A, Mirahmadizadeh A. The mental health impact of COVID-19 outbreak: a nationwide survey in Iran. Int J Ment Health Syst. 2021;15(1):19.CrossRef Shahriarirad R, Erfani A, Ranjbar K, Bazrafshan A, Mirahmadizadeh A. The mental health impact of COVID-19 outbreak: a nationwide survey in Iran. Int J Ment Health Syst. 2021;15(1):19.CrossRef
32.
go back to reference Kassardjian CD, Lennon VA, Alfugham NB, Mahler M, Milone M. Clinical features and treatment outcomes of necrotizing autoimmune myopathy. JAMA Neurol. 2015;72(9):996–1003.CrossRef Kassardjian CD, Lennon VA, Alfugham NB, Mahler M, Milone M. Clinical features and treatment outcomes of necrotizing autoimmune myopathy. JAMA Neurol. 2015;72(9):996–1003.CrossRef
33.
go back to reference Ichimura Y, Matsushita T, Hamaguchi Y, Kaji K, Hasegawa M, Tanino Y, Inokoshi Y, Kawai K, Kanekura T, Habuchi M, et al. Anti-NXP2 autoantibodies in adult patients with idiopathic inflammatory myopathies: possible association with malignancy. Ann Rheum Dis. 2012;71(5):710–3.CrossRef Ichimura Y, Matsushita T, Hamaguchi Y, Kaji K, Hasegawa M, Tanino Y, Inokoshi Y, Kawai K, Kanekura T, Habuchi M, et al. Anti-NXP2 autoantibodies in adult patients with idiopathic inflammatory myopathies: possible association with malignancy. Ann Rheum Dis. 2012;71(5):710–3.CrossRef
35.
go back to reference Kubínová K, Mann H, Vrána J, Vencovský J. How imaging can assist with diagnosis and monitoring of disease in myositis. Curr Rheumatol Rep. 2020;22(10):1–11.CrossRef Kubínová K, Mann H, Vrána J, Vencovský J. How imaging can assist with diagnosis and monitoring of disease in myositis. Curr Rheumatol Rep. 2020;22(10):1–11.CrossRef
36.
go back to reference Zheng Y, Liu L, Wang L, Xiao J, Wang Z, Lv H, Zhang W, Yuan Y. Magnetic resonance imaging changes of thigh muscles in myopathy with antibodies to signal recognition particle. Rheumatology (Oxford). 2015;54(6):1017–24.CrossRef Zheng Y, Liu L, Wang L, Xiao J, Wang Z, Lv H, Zhang W, Yuan Y. Magnetic resonance imaging changes of thigh muscles in myopathy with antibodies to signal recognition particle. Rheumatology (Oxford). 2015;54(6):1017–24.CrossRef
37.
go back to reference Reggio C, Paudel A, Specht CS, Donato AA. Necrotising myopathy and concurrent thyroiditis in a patient with COVID-19 infection. BMJ Case Rep. 2021;14(6): e242234.CrossRef Reggio C, Paudel A, Specht CS, Donato AA. Necrotising myopathy and concurrent thyroiditis in a patient with COVID-19 infection. BMJ Case Rep. 2021;14(6): e242234.CrossRef
38.
Metadata
Title
Necrotizing autoimmune myositis following coronavirus disease 2019 infection: a case report
Authors
Maryam Loghman
Ehsan Rahmanian
Majid Alikhani
Hiva Saffar
Sara Beikmohamadi Hezaveh
Mohammad Nekooeian
Reza Shahriarirad
Seyedeh Tahereh Faezi
Publication date
01-12-2022
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2022
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-022-03680-5

Other articles of this Issue 1/2022

Journal of Medical Case Reports 1/2022 Go to the issue