Dematomyositis is an inflammatory myopathy that is either autoimmune or paraneoplastic secondary to malignancy. We present a patient who developed dermatomyositis shortly after receiving intralesional immunotherapy with candida injections for treatment of warts.

Our patient is a 31-year-old female with a past medical history of warts treated with intralesional immunotherapy with candida injections to a wart on her finger. Within one month of receiving the injections she started having weakness in the thighs with difficulty standing up from a chair that progressed over 2 months and was unable to climb stairs or stand up from the floor. Neurological examination showed weakness in all muscle groups but more severely in proximal muscles. Her skin exam was remarkable for Gottron’s papules and thickening of the skin of the fingers.

Labs showed an elevated CK at 5,041. Her muscle biopsy was consistent with dermatomyositis.  The myositis antibody panel was positive for Mi-2 antibodies and CT of the chest, abdomen and pelvis was negative for malignancy. She was started on prednisone 60mg daily and she has had steady improvement in her strength on 2 month follow up.

Intralesional immunotherapy with candida is used to stimulate the immune response to the virus causing warts, human papillomavirus. There is evidence towards a systemic immune response being trigger by the fact that warts distant to the injection site also resolve. Myalgias or flu-like reactions have occurred in the small trials after injections however there are no reports of myositis or secondary autoimmune disease to this point.  The intralesional immunotherapy may have triggered an autoimmune reaction causing this patient’s dermatomyositis. As this therapy continues to become more popular it is important to assess for secondary autoimmune conditions.