A 43-year-old man reported with upper respiratory tract symptoms and tested positive for Coronavirus disease 2019 antigens. The symptoms improved quickly, but 1 month later, myalgia in both shoulders and from both thighs to both lower legs, pharyngeal pain, and dyspnoea appeared. His muscle strength was low, and laboratory tests showed an elevated serum creatine kinase level at 1273 U/L. A Coronavirus disease 2019 polymerase chain reaction test was positive on the day of admission, and a diagnosis of multisystem inflammatory syndrome in adults was considered. The patient received high-dose intravenous immunoglobulin (30 g for 5 days), as myositis due to MIS-A with muscle weakness refractory to glucocorticoids, but progressive dysphagia led to gradual reductions in ability to swallow saliva. The patient choked due to sputum, resulting in cardiopulmonary arrest on day 31. Lifesaving measures were immediately performed and the patient's heartbeat resumed. However, on day 39, the patient experienced a gastrointestinal perforation and underwent emergency surgery. Since anti-nuclear matrix protein 2 antibody-positive dermatomyositis is known as a severe form of dermatomyositis that can cause gastrointestinal perforation, we measured the antibody and found to be positive. We reported the case of gastrointestinal perforation in a patient with anti-nuclear matrix protein 2 antibody-positive dermatomyositis that developed after Coronavirus disease 2019 infection and was successfully managed through multidisciplinary therapy.
Kawamori et al. (Fri,) studied this question.