Sex: F
Vaccine: COVID19
Symptoms: Body temperature, Bronchoalveolar lavage, Bronchoscopy, Computerised tomogram thorax, Dermatomyositis
Clinical narrative: Anti-MDA5 dermatomyositis; The initial case was missing the following minimum criteria: reportable suspect drug. Upon receipt of follow-up information on 23Jun2022, this case now contains all required information to be considered valid.  This is a literature report.  A 45-year-old female patient received BNT162b2 (BNT162B2), as dose 2, single (Batch/Lot number: unknown) for covid-19 immunization. The patient's relevant medical history included: "seropositive rheumatoid arthritis" (unspecified if ongoing), notes: for nine years. Concomitant medication(s) included: UPADACITINIB taken for rheumatoid arthritis. Past drug history included: Mtx for seropositive rheumatoid arthritis; Infliximab for seropositive rheumatoid arthritis. Vaccination history included: Bnt162b2 (1st dose, 21 days prior), for COVID-19 immunization. The following information was reported: DERMATOMYOSITIS (medically significant), 3 days after the suspect product(s) administration, outcome "recovered", described as "Anti-MDA5 dermatomyositis". The patient underwent the following laboratory tests and procedures: Angiogram: showed no pulmonary embolism but, notes: demonstrated worsening GGOs and thus she was readmitted to the hospital and treated for presumed ILD flare with pulse IV steroids; Antibody test: strongly positive; Antibody test: more than 250; negative; Antinuclear antibody: 1:640, notes: (homogenous pattern); Biopsy: showed vacuolar interface dermatitis with focal, notes: interstitial granulomatous inflammation consistent with dermatomyositis; Blood creatine phosphokinase: was normal as well as her muscle strength; Body temperature: fevers; Bronchoalveolar lavage: ruled out an underlying  active infection;  Bronchoscopy: negative, notes: for bacteria, fungi, and pneumocystis-PCR; Computerised tomogram thorax: showed bilateral GGOs in the upper lobes along, notes: with reticular interstitial opacities in the peripheral lower lobes; confirmed RP-ILD due to anti-MDA5 positive, notes: IIM with demonstrable patchy bilateral consolidation and GGOs, consistent with an organizing pneumonia pattern with the "Atoll" sign; Electromyogram: showed mild myopathic, notes: features but no muscle biopsy was performed; physical examination: develop significant facial edema (heliotrope, notes: rash), worsening skin rashes over the hand joints, specifically the MCPs (Gottron's papules), toes, elbows, scalp, neck, and shoulder with worsening nonproductive cough, dyspnea, and hypoxemia; Rheumatoid factor: 484, notes: Positive; Weight: 13 kg weight loss over 2 weeks after, notes: the onset of rashes when adalimumab was  discontinued whilst the prednisone dose increased to 60 mg daily. Therapeutic measures were taken as a result of dermatomyositis.  Follow-up (23Jun2022): This is a literature follow-up report. This is a follow-up report based on the receipt of the publication; the case has been updated to include additional information identified in the publication. Updated info: reporter, literature info updated, patient age/gender added, Patient race/Relevant history/ lab data; BNT162B2 updated as suspect drug(dosage regimen added), concomitant drug added. treatment received and outcome of event updated. Time Between First Dose/Primary Event/Time between Last Dose/Primary Event added.; Sender's Comments: Linked Report(s) : US-PFIZER INC-202200889817 Same article, different patient;US-PFIZER INC-202200889816 Same article/drug/event, different patient;US-PFIZER INC-202200889814 Same article/drug/event, different patient;US-PFIZER INC-202200889813 Same article, different patient;US-PFIZER INC-PV202200008686 same article/drug/event, different patient;US-PFIZER INC-202200889815 Same article, different patient;