Management of dermatomyositis patients amidst the COVID-19 pandemic: Two case reports
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Published on: May 25, 2022
Yumeng Cao1, Jingrun Zhou1, Tingting Cao2
1Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.
Insights
This study presents two cases of dermatomyositis (DM) patients with COVID-19, highlighting the importance of accurate diagnosis and tailored treatment for this vulnerable population. Effective management requires careful consideration of individual patient characteristics and disease presentation.
Area of Science:
- Rheumatology
- Infectious Diseases
- Pulmonology
Background:
- The COVID-19 pandemic has presented unique challenges in managing patients with pre-existing autoimmune conditions.
- Dermatomyositis (DM) management in the context of COVID-19 infection remains poorly understood.
Observation:
- Two cases of patients with DM who contracted COVID-19 are reported.
- Case 1: A 67-year-old DM patient with COVID-19 presenting with fever, cough, and expectoration.
- Case 2: A 51-year-old male with interstitial lung disease associated with anti-MDA5 DM, presenting with similar respiratory symptoms.
Findings:
- The first patient received supportive care, including antiviral and anti-inflammatory treatments, leading to symptom improvement and viral clearance.
- The second patient underwent comprehensive treatment with glucocorticoids and plasma exchange, resulting in symptom relief.
- Accurate diagnosis was achieved through RT-PCR, medical history, chest CT, and specific autoantibody testing.
Implications:
- Distinguishing between COVID-19 and DM exacerbations requires repeated testing and thorough medical history evaluation.
- Personalized treatment strategies are crucial for optimizing outcomes in DM patients with COVID-19.
- Increased clinical vigilance for individual patient characteristics can enhance diagnostic and therapeutic efficacy.
Rationale:
In December 2019, a new epidemic of coronavirus disease 2019 (COVID-19) appeared in Wuhan, Hubei Province, and spread rapidly to other parts of China and worldwide. Although established methods exist for the diagnosis and treatment of COVID-19 infection, the management of dermatomyositis (DM) patients with COVID-19 is unknown.
Patient Concerns:
In this article, we describe case reports of 2 patients with DM. The first case was a 67-year-old patient with DM and infected with COVID-19 who was admitted to Leishenshan Hospital for a 1-month history of fever, cough, and expectoration. The second case was a 51-year-old male patient who was admitted to Leishenshan Hospital due to fever with cough, expectoration and shortness of breath for 1 month.
Diagnoses:
The first patient was diagnosed with COVID-19 secondary to DM based on repeated SARS-CoV-2 real-time reverse-transcriptase polymerase-chain-reaction (RT-PCR) test, detailed medical history and chest computed tomography; The second patient was diagnosed with interstitial lung disease associated with anti-MDA5 DM based on the results of antirheumatic and anti-inflammatory therapy and the above 3 methods.
Interventions And Outcomes:
The first patient received supportive and empirical treatment, including antiviral treatment, anti-inflammatory treatment, oxygen therapy and prophylactic anticoagulation therapy. The symptoms and laboratory results got improved after the treatments. He was discharged with thrice negative PCR tests for the SARS-CoV-2 virus. The second patient received a comprehensive treatment, including glucocorticoid and plasma exchange; his symptoms were relieved and improved.
Lessons:
These cases suggest that repeated new pathogenic test results for the coronavirus and a detailed diagnosis of the medical history are important means to distinguish these diseases. Increased attention to the individual characteristics of different cases may allow for more effective diagnosis and treatment.
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