We started treatment with tapered intravenous glucocorticosteroids beginning with 150?mg daily, resulting in a significant improvement of skin lesions within 2?weeks. CADM is a rare subtype of dermatomyositis with hallmark cutaneous Mouse monoclonal to BCL-10 findings but lack of myopathy. and C4 complement levels, elevated rheumatoid factor, as well as strong positivity for anti\Ro/SSA. Moreover, anti\TIF1g and anti\signal recognition particle (SRP) antibodies were found in myositis\blot (including negative antibodies for Mi\2, MDA5, NXP2, SAE1, Ku, PM\Scl100, PM\Scl75, Jo\1, PL\7, PL\12, EJ, and OJ). All other extractable nuclear antigens were unremarkable, and review of organ systems (total body computed tomography, lymph node sonography, abdominal ultrasonography, gastroscopy and colonoscopy) was normal. Moreover, clinical criteria for Citalopram Hydrobromide systemic LE were absent. A punch biopsy taken from the left upper arm revealed discrete vacuolar interface dermatitis, dermal lymphocytic infiltrates, and mucin deposition. Based on these findings, a diagnosis of CADM was made. We started treatment with tapered intravenous glucocorticosteroids beginning with 150?mg daily, resulting in a significant improvement of skin lesions within 2?weeks. CADM is a rare subtype of dermatomyositis with hallmark cutaneous findings but lack of myopathy. Importantly, a substantial risk for interstitial lung disease or malignancy exist in CADM, and solid tumours and hematologic malignancies have been reported in 89% and 11% of CADM patients, respectively. 3 Although the most common type of tumour reported Citalopram Hydrobromide in CADM is breast cancer, screening for malignancy in our patient was unremarkable. Interestingly, our patient had positive SRP antibodies, a myositis\specific antibody found in polymyositis and immune\mediated necrotizing myopathy that usually lack an association with cancer. 4 Besides tumours, a variety of Citalopram Hydrobromide other triggers have been reported for dermatomyositis, including infections, drugs, radiation, and vaccines. Several reports of cutaneous LE following SARS\CoV\2 vaccination have been recently published, and all of these cases were anti\Ro/SSA antibody positive cases of subacute cutaneous LE. 5 Enhanced production of type 1 interferons might be a key mechanism of vaccine\induced cutaneous LE, and especially anti\Ro/SSA antibody\positive individuals reveal an elevated IFN signature and increased lupus\risk. 5 Although we cannot fully exclude a cancer association of CADM in our case, the temporal correlation, rapid clinical onset and unusual autoantibody\profile (anti\Ro/SSA, anti\TIF1g, anti\SRP, lack of other malignancy\associated antibodies) could be suggestive for a causal relationship with SARS\CoV\2 vaccination. Nevertheless, simultaneous occurrence does not prove a causal connection. However, during the review process of this article, several other cases of new\onset dermatomyositis following SARS\CoV\2 vaccination were reported in the literature (Table?1). In the ongoing worldwide vaccination campaign against COVID\19, dermatologists play a key role in the interpretation of vaccine\induced cutaneous reaction patterns, and should consider SARS\CoV\2\vaccination as a potential trigger of autoimmune\mediated diseases, especially in unusual cases with unexplained trigger. Table 1 Onset of dermatomyositis following COVID\19 vaccination thead valign=”top” th align=”left” valign=”top” rowspan=”1″ colspan=”1″ Patient No. /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Reference /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Sex/age (years) /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Type of COVID vaccine /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Onset of skin lesions after vaccination /th th align=”center” valign=”top” rowspan=”1″ Citalopram Hydrobromide colspan=”1″ Antibody profile /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Other abnormal blood findings /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Signs for cancer association /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Treatment of dermatomyositis /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Outcome /th /thead 1Gouda em et?al /em . 6 F/43mRNA (BNT162b2)10?days after second injectionANA 1:80, anti\RNPCK 3358?U/L, AST 88?U/L, ALT 90?U/L, CRP 48?mg/dLNoTapered prednisolone 60?mg/day, MMF 1500?mg/day, and HQC 200?mg/daySignificant improvement in muscular strength, complete crearance of skin lesions2Wu em et?al /em . 7 F/77mRNA (BNT162b2)5?days after first injectionAnti\TIF1gCK 4476?U/L, AST 256?U/L, ALT 154?U/LNo40?mg intravenous methylprednisolone for 3?days and 2?g/kg of IVIG for Citalopram Hydrobromide 5?days, than tapered prednisone 60?mg for 4?weeks along with 1?g of MMF twice dailyMarked improvement in muscle strength3Joshida em et?al /em . 8 F/81mRNA (BNT162b2)14?days after first injectionAnti\TIF1gCK 3119?U/L, myoglobin 583?ng/mLSuspicion of advanced sigmoid colon cancerTapered prednisolone 50?mg/day and IVIGRapid improvement of muscle.