COVID-19 as a putative trigger of anti-MDA5-associated dermatomyositis with acute respiratory distress syndrome (ARDS) requiring lung transplantation, a case report.
ARDS
Anti-MDA5
COVID-19
Case report
Dermatomyositis
Lung transplantation
Journal
BMC rheumatology
ISSN: 2520-1026
Titre abrégé: BMC Rheumatol
Pays: England
ID NLM: 101738571
Informations de publication
Date de publication:
13 Jul 2022
13 Jul 2022
Historique:
received:
08
02
2022
accepted:
12
04
2022
entrez:
12
7
2022
pubmed:
13
7
2022
medline:
13
7
2022
Statut:
epublish
Résumé
Autoimmune disease following COVID-19 has been studied intensely since the beginning of the pandemic. Growing evidence indicates that SARS-CoV-2 infection, by virtue of molecular mimicry can lead to an antigen-mediated cross-reaction promoting the development of a plethora of autoimmune spectrum diseases involving lungs and extrapulmonary tissues alike. In both COVID-19 and autoimmune disease, the immune self-tolerance breaks, leading to an overreaction of the immune system with production of a variety of autoantibodies, sharing similarities in clinical manifestation, laboratory, imaging, and pathology findings. Anti-Melanoma Differentiation-Associated gene 5 dermatomyositis (anti-MDA5 DM) comprises a rare subtype of systemic inflammatory myopathies associated with characteristic cutaneous features and life-threatening rapidly progressive interstitial lung disease (RP-ILD). The production of anti-MDA5 autoantibodies was proposed to be triggered by viral infections. A 20-year-old male patient with polyarthritis, fatigue and exertional dyspnea was referred to our department. An elevated anti-MDA5 autoantibody titer, myositis on MRI, ground glass opacifications on lung CT and histological features of Wong-type dermatomyositis were confirmed, suggesting the diagnosis of an anti-MDA5 DM. Amid further diagnostic procedures, a serologic proof of a recent SARS-CoV-2 infection emerged. Subsequently, the patient deteriorated into a fulminant respiratory failure and an urgent lung transplantation was performed, leading to remission ever since (i.e. 12 months as of now). We report a unique case of a patient with a new-onset anti-MDA5 DM with fulminant ARDS emerging in a post-infectious stage of COVID-19, who underwent a successful lung transplantation and achieved remission. Given the high mortality of anti-MDA5 DM associated RP-ILD, we would like to highlight that the timely recognition of this condition and urgent therapy initiation are of utmost importance.
Sections du résumé
BACKGROUND
BACKGROUND
Autoimmune disease following COVID-19 has been studied intensely since the beginning of the pandemic. Growing evidence indicates that SARS-CoV-2 infection, by virtue of molecular mimicry can lead to an antigen-mediated cross-reaction promoting the development of a plethora of autoimmune spectrum diseases involving lungs and extrapulmonary tissues alike. In both COVID-19 and autoimmune disease, the immune self-tolerance breaks, leading to an overreaction of the immune system with production of a variety of autoantibodies, sharing similarities in clinical manifestation, laboratory, imaging, and pathology findings. Anti-Melanoma Differentiation-Associated gene 5 dermatomyositis (anti-MDA5 DM) comprises a rare subtype of systemic inflammatory myopathies associated with characteristic cutaneous features and life-threatening rapidly progressive interstitial lung disease (RP-ILD). The production of anti-MDA5 autoantibodies was proposed to be triggered by viral infections.
CASE PRESENTATION
METHODS
A 20-year-old male patient with polyarthritis, fatigue and exertional dyspnea was referred to our department. An elevated anti-MDA5 autoantibody titer, myositis on MRI, ground glass opacifications on lung CT and histological features of Wong-type dermatomyositis were confirmed, suggesting the diagnosis of an anti-MDA5 DM. Amid further diagnostic procedures, a serologic proof of a recent SARS-CoV-2 infection emerged. Subsequently, the patient deteriorated into a fulminant respiratory failure and an urgent lung transplantation was performed, leading to remission ever since (i.e. 12 months as of now).
CONCLUSIONS
CONCLUSIONS
We report a unique case of a patient with a new-onset anti-MDA5 DM with fulminant ARDS emerging in a post-infectious stage of COVID-19, who underwent a successful lung transplantation and achieved remission. Given the high mortality of anti-MDA5 DM associated RP-ILD, we would like to highlight that the timely recognition of this condition and urgent therapy initiation are of utmost importance.
Identifiants
pubmed: 35821079
doi: 10.1186/s41927-022-00271-1
pii: 10.1186/s41927-022-00271-1
pmc: PMC9277832
doi:
Types de publication
Journal Article
Langues
eng
Pagination
42Informations de copyright
© 2022. The Author(s).
Références
J Cutan Pathol. 2016 Sep;43(9):781-6
pubmed: 27161243
Rheumatol Int. 2013 Aug;33(8):2069-77
pubmed: 23404077
Lupus. 2015 Jan;24(1):3-9
pubmed: 25297551
Front Immunol. 2021 Dec 20;12:791348
pubmed: 34987516
Arthritis Care Res (Hoboken). 2013 Aug;65(8):1307-15
pubmed: 23436757
Arthritis Rheum. 2012 Nov;64(11):3736-40
pubmed: 22886382
Clin Exp Rheumatol. 2021 Jan-Feb;39(1):203-213
pubmed: 33555253
J Rheumatol. 2017 Sep;44(9):1389-1393
pubmed: 28711882
Br J Dermatol. 1969 Jul;81(7):544-7
pubmed: 5794943
Nat Rev Rheumatol. 2021 Jun;17(6):315-332
pubmed: 33903743
JAMA Netw Open. 2020 Jun 1;3(6):e2013136
pubmed: 32579195
Neuromuscul Disord. 2020 Jan;30(1):70-92
pubmed: 31791867
Cell Mol Immunol. 2021 Mar;18(3):539-555
pubmed: 33462384
Nature. 2006 May 4;441(7089):101-5
pubmed: 16625202
Diabetes. 2015 Jun;64(6):2184-93
pubmed: 25591872
Rheumatology (Oxford). 2012 May;51(5):800-4
pubmed: 22210662
Clin Exp Rheumatol. 2022 Feb;40(2):329-338
pubmed: 35225218
Front Genet. 2014 Nov 25;5:418
pubmed: 25505487
Int J Immunopathol Pharmacol. 2013 Jul-Sep;26(3):747-51
pubmed: 24067471
Clin Exp Rheumatol. 2021 May-Jun;39(3):631-638
pubmed: 33886458
Front Immunol. 2021 Oct 20;12:773352
pubmed: 34745149
J Dermatol. 2020 May;47(5):483-489
pubmed: 32096271
Curr Opin Rheumatol. 2021 Nov 1;33(6):514-521
pubmed: 34506341
Ann Rheum Dis. 2019 Jul;78(7):988-995
pubmed: 31018961
Chest. 2020 Oct;158(4):1535-1545
pubmed: 32428508
Transplant Proc. 2021 Oct;53(8):2613-2615
pubmed: 34511249
Ann Rheum Dis. 2020 Oct;79(10):1286-1289
pubmed: 32732245
Respir Med Case Rep. 2019 Jan 14;26:193-196
pubmed: 30723666
Curr Opin Rheumatol. 2021 Mar 1;33(2):155-162
pubmed: 33332890
Arthritis Rheum. 2005 May;52(5):1571-6
pubmed: 15880816
Sci Rep. 2021 Jul 1;11(1):13638
pubmed: 34211037
Cell Rep. 2021 Jan 12;34(2):108628
pubmed: 33440148
Int J Mol Sci. 2021 Aug 20;22(16):
pubmed: 34445670
Nat Commun. 2021 Sep 14;12(1):5417
pubmed: 34521836