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Vaccination as a possible trigger for immune-mediated necrotising myopathy
  1. Julia Francesca Bonato Cavalcanti1,
  2. Maria Beatriz Almeida Silva2 and
  3. Alzira Alves de Siqueira Carvalho1
  1. 1Laboratory of Neuromuscular Disease, Department of Neurosciences, Centro Universitário FMABC, Santo Andre, Brazil
  2. 2Centro Universitário FMABC, Santo Andre, SP, Brazil
  1. Correspondence to Dr Alzira Alves de Siqueira Carvalho; alzirasiqueiracarvalho{at}


Immune-mediated necrotising myopathy is a rare autoimmune myopathy characterised by severe progressive muscle weakness, elevated levels of creatine kinase (CK), and necrosis with minimal inflammatory cell infiltration on muscle biopsy. We report a case of a previously healthy 42-year-old woman who presented with progressive muscle weakness 2 weeks after immunisation for yellow fever, tetanus/diphtheria and hepatitis B. Her symptoms started from the lower limbs and progressed to the upper limbs and cervical region associated with dysphagia, making her wheelchair bound. Electromyography showed a myopathic pattern, with a CK level of 12.177 U/L (reference value: 26–190 U/L), and biceps brachial muscle biopsy confirmed necrosis and regeneration fibres. The immunoblot test was positive for antisignal recognition particle. She was successfully treated with prednisone (1 mg/kg/day). Although considered safe, vaccines may cause allergic reactions or trigger autoimmune disorders. Currently, a causal relationship between them cannot be established.

  • immunological products and vaccines
  • neuromuscular disease
  • muscle disease

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  • Contributors JFBC and MBAS are medical students and, together with their Professor advisor Dr AAdSC, they analysed the history of the patient and then wrote the case report according to Dr AAdSC guidance and corrections.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.