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A 24-year-old man developed myalgias and bilateral upper and lower extremity weakness without skin changes. Markedly elevated creatine kinase exceeded 300,000 U/L, while inflammatory markers, autoimmune screening, and chest CT findings lacked interstitial lung disease. Initial fluids for presumed viral rhabdomyolysis produced minimal improvement, whereas empiric steroids led to rapid recovery. Muscle biopsy confirmed necrotizing myositis and antibody testing showed elevated MDA5 levels.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/covid-19-associated-mda5-mediated-necrotizing-myositis-case-report/435031/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/covid-19-associated-mda5-mediated-necrotizing-myositis-case-report/435031.png","ImageObject",300,407,{"name":92,"@type":93},"Elsa","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What condition is reported in this case?","Question",{"text":113,"@type":114},"The case documents necrotizing myopathy (necrotizing myositis) mediated by MDA5 antibodies following a recent SARS-CoV-2 infection.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which initial findings made diagnosis difficult?",{"text":118,"@type":114},"Symptoms and markedly high creatine kinase levels overlapped with viral-induced rhabdomyolysis, while inflammatory markers and a basic autoimmune panel were not initially supportive, and chest CT did not show interstitial lung disease.",{"name":120,"@type":111,"acceptedAnswer":121},"Why was steroid therapy effective?",{"text":122,"@type":114},"After minimal improvement with intravenous fluids for presumed viral rhabdomyolysis, empiric steroid treatment led to rapid recovery in both CK levels and symptoms, consistent with an autoimmune necrotizing myositis process confirmed by biopsy and MDA5 antibody elevation.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},435031,1790765668,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":46,"preview_page_count":4},137455077381,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","e-ISSN 1941-5923  \n© Am J Case Rep, 2025; 26: e949788 DOI: 10. 12659/AJCR.949788  \nReAccceeivedpted:: 20252025..0510..1121 COVID-19-Associated MDA5-Mediated Necrotizing AvailabPleubonline:lished: 20252025..1112..1517 Myositis  \nABCDEF 1 Sarah Steadman*  \nABCDEF 2 Amit Sikder*  \nABCDEF 3 Harsh R. Desai   \nBE 4 Bradley Collins   \nBDE 5 Tiffany Baker  \nABCDEF 6 Julie Worthington  \nAuthors’ Contribution: Study Design A  \nData Collection B Statistical Analysis C Data Interpretation D Manuscript Preparation E Literature Search F Funds Collection G  \n1 Edward Via College of Osteopathic Medicine-Carolinas Campus, Spartanburg, SC, USA  \n2 The University of Queensland Medicine Program, Herston, Queensland, Australia  \n3 Trident Medical Center, Charleston, SC, USA  \n4 Low Country Rheumatology, Charleston, SC, USA  \n5 Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA  \n6 TeamHealth, Trident Medical Center, Charleston, SC, USA  \n* Sarah Steadman and Amit Sikder Co-primary authors Corresponding Author: Harsh R. Desai, e-mail: [harsh.desai@uq.net.au](harsh.desai@uq.net.au)  \nFinancial support: This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity Conflict of interest: None declared  \nPatient: Male, 24-year-old  \nFinal Diagnosis: Necrotizing myopathy  \nSymptoms: Myalgia  \nClinical Procedure: —  \nSpecialty: Rheumatology  \nObjective: Rare disease  \nBackground: Rhabdomyolysis and autoimmune myopathies often present with similar clinical features, including myalgias, muscle weakness, and elevated serum creatine kinase (CK) levels. This overlap can make early diagnosis challenging and delay appropriate management. The recent rise in SARS-CoV-2 infections has led to an increasing number of reports of autoimmune myositis associated with the virus.  \nCase Report: Here, we present a unique case of a young African American male who developed myalgias and bilateral upper and lower extremity weakness without any skin changes following a recent SARS-CoV-2 infection. His CK level exceeded 300 000 U/L; however, he had normal inflammatory markers and a basic autoimmune panel, anda chest computed tomography scan did not demonstrate interstitial lung disease. Initial treatment with intravenous fluids for presumed viral-induced rhabdomyolysis showed minimal clinical improvement. Surprisingly, empiric steroid therapy led to a rapid recovery in both CK levels and symptoms. A subsequent muscle biopsy revealed necrotizing myositis, and an autoimmune myositis panel showed elevated melanoma differentiationassociated gene 5 (MDA5) antibodies.  \nConclusions: To the best of our knowledge, this is the first reported case of MDA5-associated necrotizing myositis following SARS-CoV-2 infection. Most patients with MDA5-related disease develop skin changes and underlying interstitial lung disease; however, our patient lacked these findings. At an 8-month outpatient follow-up, the patient had residual proximal muscle weakness and remained on immunosuppressive therapy. Further research is needed to better understand the pathophysiology of COVID-19-mediated autoimmune myopathies and to develop targeted therapies for these patients.  \nKeywords: Autoimmune Diseases • COVID-19 • Myositis • Rhabdomyolysis • Rheumatology  \nFull-text PDF: [https://www.amjcaserep.com/abstract/index/idArt/949788](https://www.amjcaserep.com/abstract/index/idArt/949788)  \n1991  3  2  24  \nPublisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher  \nThis work is licensed under Creative Common AttributionNonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)  \ne949788-1  \nIndexed in: [PM","cbCairdmHpIaUrd1","https://ap.wps.com/l/cbCairdmHpIaUrd1","pdf",474236,"English","# Introduction\n# Case Report\n# Conclusions","[{\"question\":\"What condition is reported in this case?\",\"answer\":\"The case documents necrotizing myopathy (necrotizing myositis) mediated by MDA5 antibodies following a recent SARS-CoV-2 infection.\"},{\"question\":\"Which initial findings made diagnosis difficult?\",\"answer\":\"Symptoms and markedly high creatine kinase levels overlapped with viral-induced rhabdomyolysis, while inflammatory markers and a basic autoimmune panel were not initially supportive, and chest CT did not show interstitial lung disease.\"},{\"question\":\"Why was steroid therapy effective?\",\"answer\":\"After minimal improvement with intravenous fluids for presumed viral rhabdomyolysis, empiric steroid treatment led to rapid recovery in both CK levels and symptoms, consistent with an autoimmune necrotizing myositis process confirmed by biopsy and MDA5 antibody elevation.\"}]","COVID-19-Associated MDA5-Mediated Necrotizing Myositis - Case Report | PDF",1790671514]