A Case of New-onset Immune-mediated Necrotizing Myopathy and Trigeminal Neuropathy after SARS-CoV-2 mRNA Vaccination in a Patient with Rheumatoid Arthritis and Sjögren's Syndrome

Takuma Tsuzuki Wada; Kazuhiro Yokota; Fumito Inayoshi; Sakon Sakai; Nobuhito Okumura; Mayumi Matsuda; Iichiro Osawa; Yasuto Araki; Yu Funakubo Asanuma; Yuji Akiyama; Toshihide Mimura

doi:10.2169/internalmedicine.2551-23

This article has now been updated. Please use the final version.

A Case of New-onset Immune-mediated Necrotizing Myopathy and Trigeminal Neuropathy after SARS-CoV-2 mRNA Vaccination in a Patient with Rheumatoid Arthritis and Sjögren's Syndrome

Takuma Tsuzuki Wada, Kazuhiro Yokota, Fumito Inayoshi, Sakon Sakai, Nobuhito Okumura, Mayumi Matsuda, Iichiro Osawa, Yasuto Araki, Yu Funakubo Asanuma, Yuji Akiyama, Toshihide Mimura

Author information

Takuma Tsuzuki Wada
Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
Kazuhiro Yokota
Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
Fumito Inayoshi
Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
Sakon Sakai
Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
Nobuhito Okumura
Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
Mayumi Matsuda
Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
Iichiro Osawa
Department of Radiology, Saitama Medical University Hospital, Japan
Yasuto Araki
Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
Yu Funakubo Asanuma
Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
Yuji Akiyama
Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
Toshihide Mimura
Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan

Keywords: SARS-CoV-2 mRNA vaccine, immune-mediated necrotizing myopathy, trigeminal neuropathy, rheumatoid arthritis, Sjögren's syndrome

JOURNAL OPEN ACCESS Advance online publication

Article ID: 2551-23

DOI https://doi.org/10.2169/internalmedicine.2551-23

The final version of this article is now available: Vol. 62 (2023), No. 24 pp. 3699-3706

Details

Abstract

We present the case of a 42-year-old woman with rheumatoid arthritis and Sjögren's syndrome treated with adalimumab who developed immune-mediated necrotizing myopathy (IMNM) and trigeminal neuropathy after SARS-CoV-2 mRNA vaccination. Trigeminal neuralgia and elevated serum creatine kinase levels emerged 12 days post-vaccination, followed by myalgia in the femoral muscles. IMNM was histologically diagnosed. The pathogenesis may involve molecular mimicry between the SARS-CoV-2 spike glycoprotein and autologous tissues triggered by vaccination. This case emphasizes the association between SARS-CoV-2 vaccination, tumor necrosis factor inhibitor, IMNM, and trigeminal neuropathy, as well as the importance of monitoring immune-mediated adverse events following SARS-CoV-2 vaccination in patients with autoimmune disease.

Corresponding author

Register with J-STAGE for free!