PMC9271786_01
Manifestations of COVID-19-associated anti-MDA5 dermatomyositis. (A) Cutaneous manifestations presented as violaceous, maculo-papular lesions on both dorsal and volar sides. (B) Nailfold video-capillaroscopy illustrated reduced capillary density, neo-angiogenesis, and tortuous, ectasic and giant capillaries. (C) Anti-MDA5 antibodies detected by immunoprecipitation. (D, E) T1-weighted cardiac magnetic resonance images presenting increased signal intensity [native T1 = 1067 +- 37msec (NV < 1015)], which, in association with ECV = 30 +- 4% (NV < 29) and normal T2 intensity [native T2 = 46 +- 3 msec (NV < 50 msec)], indicates interstitial myocardial fibrosis and is consistent with previous myocarditis. (F) Skin punch biopsy of a Gottron-like lesion on the left hand showing patchy mixed superficial inflammatory infiltrated with leukocytoclastic vasculitis features (Hematoxylin and eosin, 20x magnification).
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For the persistence of skin rash, Gottron-like lesions on her hands ( Figure 1 ), and arthralgias, she was admitted to our Department of Rheumatology and Clinical Immunology in March 2021. A nailfold video-capillaroscopy showed reduced capillary density, neo-angiogenesis, and giant capillaries ( Figure 1 ). No abnormalities were found on EKG and echocardiography, but cardiac magnetic resonance imaging (MRI) findings were consistent with interstitial fibrosis as mirrored by increased native T1 mapping time ( Figure 1  ). We followed the search strategy and article selection process illustrated in the flowchart in  Supplementary Figure 1 , according to the recommendations of the PRISMA statement.