FIGURE 1.

Disease course with associated creatine kinase changes and treatment. The first and second doses of vaccine were injected into the right deltoid muscle. Fatigue and weakness persisted for 3 weeks after the first vaccine dose. The patient had difficulty getting up from a chair and climbing stairs. Anti–signal recognition particle autoantibodies were identified by the immunoblot method on UROIMMUN's EUROBlotMaster. Despite treatment with intravenous immunoglobulin of 1 to 2 g/kg every 4 weeks, high‐dose prednisone, and methotrexate, follow‐up (6‐9 months) assessments demonstrated residual weakness graded 3 to 4/5 on the Medical Research Council scale bilaterally in the proximal muscles of the upper and lower extremities with persistently elevated creatine kinase levels