Document Type : Case Report
Authors
1 Dermatology, IRCCS Policlinico di Sant’Orsola, via Massarenti 9, 40138, Bologna, Italy
2 Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40138 Bologna, Italy
3 Rheumatology, IRCCS Policlinico di Sant’Orsola, Department of Medical and Surgical Sciences (DIMEC) Alma Mater Studiorum University of Bologna, Italy
4 Allergy and Clinical Immunology, Internal Medicine - IRCCS Policlinico di Sant’Orsola, Department of Medical and Surgical Sciences (DIMEC) Alma Mater Studiorum University of Bologna, Italy
Abstract
We report a case of clinically amyopathic dermatomyositis (CADM) with anti-MDA5 positivity associated with rapidly progressive interstitial lung disease. The analogies between CADM-associated interstitial lung disease and coronavirus disease 2019 (COVID-19) pneumonia may hinder the diagnosis and delay the start of immunosuppressive therapy. High-resolution computed tomography revealed an evident worsening of the bilateral consolidation, interlobular septal thickening, and ground-glass opacities, highlighting the diagnosis of rapidly progressive interstitial lung disease. The radiological presentation, combined with the laboratory findings, underscored the diagnosis of CADM. In the following days, the respiratory failure progressed, and the patient required extracorporeal membrane oxygenation and lung transplantation. The typical cutaneous rash of dermatomyositis and non-pulmonary clinical differences can help the physician reach a correct diagnosis. Assessing patients with interstitial lung diseases during the COVID-19 pandemic is difficult. Through experience with systemic autoimmune diseases such as clinically amyopathic dermatomyositis, we can develop new pathophysiology models and therapeutic strategies for COVID-19.
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