Anti-MDA5 dermatomyositis after COVID-19 vaccination: a case-based review

Rheumatol Int. 2022 Sep;42(9):1629-1641. doi: 10.1007/s00296-022-05149-6. Epub 2022 Jun 4.

Abstract

Anti-MDA5 (Melanoma differentiation-associated protein 5) myositis is a rare subtype of dermatomyositis (DM) characterized by distinct ulcerative, erythematous cutaneous lesions and a high risk of rapidly progressive interstitial lung disease (RP-ILD). It has been shown that SARS-CoV-2 (COVID-19) replicates rapidly in lung and skin epithelial cells, which is sensed by the cytosolic RNA-sensor MDA5. MDA5 then triggers type 1 interferon (IFN) production, and thus downstream inflammatory mediators (EMBO J 40(15):e107826, 2021); (J Virol, 2021, https://doi.org/10.1128/JVI.00862-21 ); (Cell Rep 34(2):108628, 2021); (Sci Rep 11(1):13638, 2021); (Trends Microbiol 27(1):75-85, 2019). It has also been shown that MDA5 is triggered by the mRNA COVID-19 vaccine with resultant activated dendritic cells (Nat Rev Immunol 21(4):195-197, 2021). Our literature review identified one reported case of MDA5-DM from the COVID-19 vaccine (Chest J, 2021, https://doi.org/10.1016/j.chest.2021.07.646 ). We present six additional cases of MDA5-DM that developed shortly after the administration of different kinds of COVID-19 vaccines. A review of other similar cases of myositis developing from the COVID-19 vaccine was also done. We aim to explore and discuss the evidence around recent speculations of a possible relation of MDA5-DM to COVID-19 infection and vaccine. The importance of vaccination during a worldwide pandemic should be maintained and our findings are not intended to discourage individuals from receiving the COVID-19 vaccine.

Keywords: COVID-19 vaccine; Dermatomyositis; MDA5.

Publication types

  • Review

MeSH terms

  • Autoantibodies
  • COVID-19 Vaccines* / adverse effects
  • COVID-19* / prevention & control
  • Dermatomyositis* / etiology
  • Humans
  • Interferon-Induced Helicase, IFIH1
  • Lung Diseases, Interstitial* / etiology
  • SARS-CoV-2
  • Vaccination

Substances

  • Autoantibodies
  • COVID-19 Vaccines
  • Interferon-Induced Helicase, IFIH1