A case of corticosteroid-responsive SARS-CoV-2 related massive rhabdomyolysis

Cunha, Maria Luzia Chollopetz da; Pinho, Inês Soares de; Lopes, Marta; Trigueiros, Frederico; Bráz, Sandra; Medeiros, Fábio

doi:10.1016/j.idcr.2020.e00946

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…Exposure to myotoxic medication could be identified in 18 patients. Myotoxic drugs these patients were taking at the time rhabdomyolysis occurred included azithromycin, hydroxy-chloroquine, placitaxel [5], propofol [6], imastinib, piperacillin and meropenem, hydrochlorothiazide, and acetaminophen (Table). Typical clinical manifestations of rhabdomyolysis (myalgia, dark urine, fever, fatigue, vomiting, diarrhoea) were reported in 20 patients and remained unreported in 10 cases.…”

Section: Resultsmentioning

confidence: 99%

SARS-CoV-2 associated rhabdomyolysis in 32 patients

Finsterer¹,

Scorza²

2021

Turk J Med Sci

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Background/aim: This mini-review aims at summarising and discussing previous and recent findings concerning the clinical manifestations, therapeutic management, and outcome of SARS-CoV-2 associated rhabdomyolysis. Materials and methods: literature search in the PubMed database applying appropriate search terms. Results: identified were 26 articles reporting SARS-CoV-2 associated rhabdomyolysis in 32 patients. Age ranged from 16 to 80 years. Four patients were female and 25 male. Onset of rhabdomyolysis was prior to onset of COVID-19 in 7 patients, and after onset of COVID-19 in the remaining patients. Exposure to myotoxic medication was identified in 18 patients. Myotoxic drugs these patients were taking at the time rhabdomyolysis included azithromycin, hydroxy-chloroquine, placitaxel, propofol, imastinib, piperacillin and meropenem, hydrochlorothiazide, and acetaminophen. Peak creatine-kinase values ranged from 328 to >427656 U/l. The outcome was unreported in 8 cases, favourable in 15 cases, incomplete in 3 cases, and lethal in 6 cases. Conclusions: SARS-CoV-2 associated rhabdomyolysis is rare, may be most frequently due to side effects of myotoxic anti-COVID-19 drugs, and only rarely due to virus myositis, and may have a favourable outcome in most patients.

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Section: Resultsmentioning

confidence: 99%

SARS-CoV-2 associated rhabdomyolysis in 32 patients

Finsterer¹,

Scorza²

2021

Turk J Med Sci

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“…Bis November 2020 sind mindestens 38 Fälle einer COVID-19-assoziierten Rhabdomyolyse beschrieben worden, von denen 10 tödlich verliefen. Einschränkend muss hinzugefügt werden, dass bei einigen Patienten eine Komedikation mit möglicherweise myotoxischen Substanzen bestand, wie beispielsweise Imatinib [ 12 , 33 ], Paclitaxel [ 11 , 36 ] oder Rosuvastatin [ 1 ]. Histopathologische Untersuchungen bzw.…”

Section: Rhabdomyolyseunclassified

“…Virusinfektionen sind bei Kindern eine häufigere Ursache, bei Erwachsenen sind Substanzkonsum, Trauma und epileptische Anfälle häufige Auslöser, Virusinfektionen, bis auf Influenza A, hingegen sehr selten. In der Literatur sind mindestens 38 Fälle einer Rhabdomyolyse während oder nach einer COVID-19-Infektion beschrieben: Diese kann sowohl früh in der Erkrankungsphase, offenbar auch als erstes Symptom [35], als auch im späteren klinischen Verlauf [5,11] auftreten. Die Serum-CK-Werte können dabei Werte bis zu mehr als 6688 μmol/sl im Verlauf annehmen [5].…”

Section: Rhabdomyolyseunclassified

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Neuromuskuläre Komplikationen einer SARS-CoV-2-Infektion – Teil 2: Erkrankungen der Muskulatur

et al. 2021

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Neben Störungen und Erkrankungen peripherer Nerven sind in den letzten Monaten im Zusammenhang mit COVID-19 („coronavirus disease 2019“) auch Begleitsymptome und Störungen der Muskulatur bzw. der neuromuskulären Transmission beschrieben worden. Im zweiten Teil unserer Zusammenfassung geben wir eine Übersicht über häufig berichtete Symptome wie Myalgien und definierte Erkrankungen wie Rhabdomyolysen, Myositiden, Myasthenie und „intensive care unit acquired weakness“ (ICUAW), die im Rahmen eine SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Infektion bzw. COVID-19 beschrieben wurden. Darüber hinaus werden Kriterien für eine Kausalität wie Effektstärke, Plausibilität, Zeitverlauf und experimentelle Evidenz für einen kausalen Zusammenhang der in beiden Teilen der Übersicht beschriebenen COVID-19 assoziierten neuromuskulären Erkrankungen diskutiert. Zum jetzigen Zeitpunkt sind – neben der auch in der Laienpresse bekannten Geruchssinnstörung – vor allem Myalgien als unspezifisches Symptom häufige Folge einer symptomatischen SARS-CoV‑2 Infektion. Andere neuromuskuläre Komplikationen erscheinen hinsichtlich ihrer Pathogenese prinzipiell plausibel, aber offenbar selten Folge einer SARS-CoV-2-Infektion zu sein. Prospektive bzw. Kohortenstudien sind notwendig, um eine Kausalität zu bestätigen und das Risiko abzuschätzen.

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Paclitaxel

2020

Reactions Weekly

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Rhabdomyolysis secondary to immune reconstitution inflammatory syndrome: case report A 46-year-old woman developed rhabdomyolysis secondary to immune reconstitution inflammatory syndrome following treatment with paclitaxel for breast cancer [route, dosage and time to reaction onset not stated]. The woman, who had been diagnosed with breast cancer in September 2019, was receiving neoadjuvant chemotherapy with paclitaxel. She received her sixth cycle of paclitaxel on 3 rd April 2020. Prior to the next paclitaxel cycle, she underwent SARS-CoV-2 PCR screening test which showed positive result. She was asymptomatic. She was admitted to the isolation ward of a hospital in Portugal. During the first 15 days of hospital stay, she complained of occasional nausea and diffuse myalgia. On 2 nd May, she presented with vomiting, abdominal pain and new-onset fever. Laboratory investigations revealed elevated levels of CRP, amylase, transaminases, lactate dehydrogenase and γ glutamyltrasferase. Concurrent de novo lymphopenia and slight thrombocytopenia were also observed. Urine sediment analysis revealed unspecific alterations. The woman was treated with paracetamol and metoclopramide. Symptomatic relief was noted. Over the following two days, she developed diarrhoea and dry cough. On 5 th May, 19 days after admission, chest X-ray showed a COVID-19 related significant bilateral infiltrate with upper left lung consolidations. Laboratory investigation revealed marked increase in levels of creatine kinase, lactate dehydrogenase, ferritin and IL-6. Her CRP , transaminases, γ glutamyltrasferase, amylase and lipase levels also increased further. She was diagnosed with rhabdomyolysis related to COVID-19. Serology for SARS-CoV-2 showed antibody response. Nasopharyngeal swab was still positive for SARS-CoV-2 RNA. One month had passed since her last paclitaxel cycle. Metoclopramide was discontinued. A cytokine-mediated response in the wake of post-chemotherapy immune reconstitution was strongly suspected, based on the laboratory results and signs of multiorgan damage. She was initiated on methylprednisolone, hydroxychloroquine and bicarbonate. Over the following 48 hours, marked relief of myalgia, diarrhoea and asthenia were observed. Her cough became less intense and her fever resolved. Laboratory investigation revealed recovery of lymphocyte counts as well as decreasing in levels of creatine kinase, lactate dehydrogenase, CRP, liver enzymes and ferritin. She was diagnosed with immune reconstitution inflammatory syndrome secondary to paclitaxel therapy. Methylprednisolone was weaned off and then switched to prednisolone. Hydroxychloroquine was also discontinued. After 10 days of methylprednisolone therapy, a deltoid muscle biopsy performed. No viral RNA was detected in the muscle sample. Pathology did not show any inflammatory infiltrates or signs of muscle damage. The immune reconstitution inflammatory syndrome was suspected to have contributed in the development of rhabdomyolysis. She was discharged on the 10 th day of corticosteroids ...

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A case of corticosteroid-responsive SARS-CoV-2 related massive rhabdomyolysis

Cited by 5 publications

References 18 publications

SARS-CoV-2 associated rhabdomyolysis in 32 patients

SARS-CoV-2 associated rhabdomyolysis in 32 patients

Neuromuskuläre Komplikationen einer SARS-CoV-2-Infektion – Teil 2: Erkrankungen der Muskulatur

Paclitaxel

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