Neuroimmunology
COVID-19 related autoimmune myopathy: 5 cases report
Yang Mengting, Zhao Yawen, Wang Yikang, Yuan Jingchu, Deng Jianwen, Liu Jing, Zheng Yiming, Zhang Wei, Wang Zhaoxia, Yuan Yun
Published 2024-01-08
Cite as Chin J Neurol, 2024, 57(1): 40-46. DOI: 10.3760/cma.j.cn113694-20231010-00222
Abstract
ObjectiveTo analyze the clinical characteristics, imaging, myopathology and outcomes of patients with COVID-19 related autoimmune myopathy.
MethodsThe clinical features, serum creatine kinase (CK), myositis antibodies, muscle magnetic resonance imaging, myopathology and therapy of 5 patients with COVID-19 related autoimmune myopathy diagnosed in Peking University First Hospital from December 2022 to April 2023 were collected. The effects of the therapy after a short term follow up were analyzed.
ResultsAmong the 5 patients, there were 3 males and 2 females, with onset age of 42-86 years. All patients presented with proximal muscle weakness in the recovery term of COVID-19. Myalgia was noted in 3 cases, dysphagia in 1, skin damage in 2, interstitial lung disease in 1. The serum CK of the 5 patients was 1 663-16 000 IU/L, 1 patient had anti-3-hydroxy-3-methylglutaryl-CoA reductase autoantibodies and 1 patient had anti-signal recognition particle autoantibodies. The electromyography showed myogenic lesions in all patients. Muscle magnetic resonance imaging showed diffuse muscle edema in all patients, myofascial edema in 3 and subcutaneous-tissue edema in 3. The muscle biopsies in 4 patients revealed necrotic myopathy,with high P62 expression in muscle fibers. The electromicroscopy of 2 patients revealed vacuolated mitochondria and intranuclear tubulofilamentous inclusions in muscle fibers. Four patients were treated with glucocorticoids, of whom 2 patients combined with intravenous immunoglobulin, tacrolimus or cyclophosphamide. One case had close monitoring without drug therapy. They showed significant improvement, but the CK was still abnormal in 4 patients.
ConclusionsCOVID-19 leads to immune mediated myopathy. The manifestation of patients is characterized by proximal predominant weakness and high creatine kinase level. Muscle magnetic resonance imaging shows diffuse muscle edema. The muscle biopsies reveal necrotic myopathy. The effectiveness of immunosuppression needs to be further studied.
Key words:
COVID-19; Myositis; Immune-mediated necrotizing myopathy
Contributor Information
Yang Mengting
Department of Neurology, Peking University First Hospital, Beijing 100034, China
Zhao Yawen
Department of Neurology, Peking University First Hospital, Beijing 100034, China
Wang Yikang
Department of Neurology, Peking University First Hospital, Beijing 100034, China
Yuan Jingchu
Department of Neurology, Peking University First Hospital, Beijing 100034, China
Deng Jianwen
Department of Neurology, Peking University First Hospital, Beijing 100034, China
Liu Jing
Department of Neurology, Peking University First Hospital, Beijing 100034, China
Zheng Yiming
Department of Neurology, Peking University First Hospital, Beijing 100034, China
Zhang Wei
Department of Neurology, Peking University First Hospital, Bejing Key Laboratory of Neurovascular Disease, Beijing 100034, China
Wang Zhaoxia
Department of Neurology, Peking University First Hospital, Bejing Key Laboratory of Neurovascular Disease, Beijing 100034, China
Yuan Yun
Department of Neurology, Peking University First Hospital, Bejing Key Laboratory of Neurovascular Disease, Beijing 100034, China
