Disclosures: Timothy G. Bazil, DO: No financial relationships or conflicts of interest

Case Diagnosis: Necrotizing Myopathy Following COVID-19 Vaccination: a case report

Case Description or Program Description: An 86-year-old male presented with bilateral LE weakness and dark urine four days after administration of second dose of COVID-19 vaccination. He was diagnosed with UTI by his PCP. On admission to hospital, workup revealed elevated CK and elevated inflammatory markers. Serological workup was negative for autoimmune disease.

Setting: Major academic and referral center with Level I adult trauma and Level II pediatric trauma status

Assessment/Results: His initial diagnosis was attributed to inflammatory myositis versus rhabdomyolysis. He was started on intravenous steroids. A thigh biopsy demonstrated necrotizing myopathy, and etiology was attributed to COVID-19 vaccination. EMG was not warranted given established diagnosis. He was ultimately discharged to a subacute rehabilitation facility for functional improvement.

Discussion (relevance): This case demonstrates a patient with a rare and unusual side effect attributed to COVID-19 vaccination. While the differential could include a statin-induced myopathy, it is unlikely given he had been on the same statin for several years. The other etiology could certainly be idiopathic, but chronological proximity to the vaccine seems too coincidental. There has been a case in the literature describing a female patient who experienced left UE progressive weakness and myalgias at the site of her second COVID-19 vaccination. MRI of the left shoulder showed diffuse edema and inflammation consistent with myositis. She did not have muscle biopsy. It has been documented that muscle is subject to modified contaminated agents through direct inoculation which can consequently trigger an immune response to the injected antigen.

Conclusions: This is an elderly patient who developed progressive LE paraparesis after COVID-19 vaccination attributed to necrotizing myopathy based on muscle biopsy. Further studies should investigate the incidence of necrotizing myopathy from the novel mRNA COVID-19 vaccination as it may be underdiagnosed, and if there are other predisposing factors for individuals to develop such pathology.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/necrotizing-myopathy-following-covid-19-vaccination-a-case-report/