¹Ghadeer Shafiq Alabbadi, ¹Khaled Alderaan, ¹Nadya Alfaraidy, ²Mustafa AlQarni

¹King Fahad Specialist Hospital, ²King Fahad Hospital of University

Background(s):  Drug-induced myopathy can be defined by a clinical presentation that includes myalgia and muscle weakness, laboratory findings of high CK levels, or the presence of myoglobulin in the clinical context of using some medication known or reported as a cause of myopathy.

Method(s): Highlight the possibility of induction of acute onset of DM after COVID infection which need to be more investigated and considered by physicians treating patent with high levels of blood glucose and its complications following COVID 19 infection. Here we present a case of young patient with newly diagnosed type 1 diabetes mellitus after a recent COVID 19 infection.

Result(s): The typical clinical findings, along with high CK level and absence of muscle irritability were all consistent with the diagnosis of Drug-induced myositis. Ustekinumab and atorvastatin were both discontinued at this point. CK level started to trend down gradually to a normal level without any intervention added over 7 months. The role of positive anti-HMGCR results with high titer has been highlighted recently as useful specific Biomarkers for anti-HMGCR myositis in the setting of a good clinical context (ie. Presence of muscle weakness, and high CK level in patients with statin use). But still, the course of myositis was self-limited with no immunosuppressive medication added as commonly needed to treat anti-HMGCR myositis. This unique antibody was not detected in self-limited Statin myopathy conditions included in some cohort studies previously.

Conclusion(s): In the end, we conclude that Ustekinumab was the likely trigger of myositis in our case. There are tow cases reported previously of myositis associated to Ustekinumab use. This potential adverse event should be taken into account when we follow our patients who are on Ustekinumab therapy. The knowledge is lacking behind the exact underlying pathophysiology.