COVID-19 or clinical amyopathic dermatomyositis associated rapidly progressive interstitial lung disease? A case report

• Main Authors: Mengke Cao, Shuangshuang Zhang, Dejie Chu, Ming Xiao, Xiaohong Liu, Lingling Yu, Jing Li, Yi Huang, Fang Fang
• Format: Article
• Language: English
• Published: BMC 2020-11-01
• Series: BMC Pulmonary Medicine
• Subjects: Clinical amyopathic dermatomyositis; Rapidly progressive interstitial lung disease; COVID-19; Anti-Ro52 antibody; Gottron’s sign; Gottron’s papules
• Online Access: http://link.springer.com/article/10.1186/s12890-020-01335-z

Abstract Background Coronavirus disease 2019 (COVID-19) has reach pandemic proportions globally. For patients with symptoms of fever and cough accompanied by rapid lung damage progression, COVID-19 needs to be distinguished from interstitial lung disease (ILD) attributed to connective tissue disease (CTD), especially dermatomyositis (DM)/clinical amyopathic dermatomyositis (CADM) associated rapidly progressive interstitial lung disease (RP-ILD). Case presentation We report a case of a woman observed with fever, cough, and rapid lung damage during the epidemic. The patient had a suspicious epidemiological history, and her chest CT scans showed lung damage similar to that caused by COVID-19, but anti-Ro52 antibody was strongly positive. She was diagnosed with CADM associated RP-ILD and died 1 month later. Conclusions During the COVID-19 epidemic, it is critical to carefully assess patients with CTD related ILD, especially RP-ILD associated with CADM. Repeated nucleic acid tests for COVID-19 are necessary to achieve accurate case diagnosis. High-resolution CT (HRCT) of the chest is presently deemed an inefficient technique to distinguishing between COVID-19 and CADM associated RP-ILD. The characteristic rashes of dermatomyositis require careful observation and can often provide diagnostic clues. For patients with CADM, a high titers of anti-Ro52 antibody may be related to the pathogenesis of RP-ILD, suggesting a poor prognosis.