Polymyositis following Pandemic Influenza A (H1N1) and 2009-10 Seasonal Trivalent Vaccines

Table 1

	Patient 1	Patient 2	Patient 3
Sex/age (y)/race/smoke	F/59/Afro-American/—	M/60/African/—	F/71/Caucasian/—
Symptoms	Fever, cough, dyspnea, diffuse lung infiltrates, proximal muscle weakness	Fever, cough, dyspnea, basilar lung infiltrates, proximal muscle weakness	Proximal muscle weakness, severe dysphagia, periungueal erythema, periocular bullous heliotropic lesions
Onset after vaccination	5 days	30 days	7 days
CK (nv < 170 U/L) 1-2-3	2,685-569-98	6,589-1,700-752	1,325-67-20
EMG myogenic alterations	+	+	+
Autoimmunity	ANA 1 : 640 (speckled); ENA- ASMA-; AMA-; ANCA-	ANA 1 : 320 (speckled); ENA+ (Jo1); ASMA+ 1 : 160; AMA-; ANCA-	ANA 1 : 320 (speckled); ENA+ (Ro/SSA); AMA-; ASMA-; ANCA-
Treatment	6-MP 1 mg/Kg/day → slowly tapered to 8 mg/day; Mycophenolate mofetil 2 g/day from February 2010	Predn. 1.5 mg/Kg/day → slowly tapered to 25 mg/day Methotrexate 20 mg/week; IVIG 1 mg/kg monthly (February–May 2010); start of Cyclosporine 200 mg/day from September 2010	6-MP 1 mg/Kg/day → slowly tapered to 16 mg/day; IVIG 1 mg/kg monthly (March–August 2010)
Outcome	Remission	Partially improved	Died in November 2010 (Epstein-Barr virus reactivation)

CK: creatinine kinase (1: at baseline; 2: 1 month after therapy beginning; 3: at the end of followup, in December 2010); EMG: electromyography; ANA: antinuclear antibodies; anti-ENA: antiextractable nuclear antigen antibodies; ASMA: antismooth muscle antibodies; AMA: antimitochondrial antibodies; ANCA: antineutrophil cytoplasmic antibodies; 6-MP: 6-methylprednisolone, Predn: prednisone.