Case Report: A COVID-19 Patient Presenting with Mild Rhabdomyolysis

Abstract

The news was reported from the Wuhan region of China about a novel corona virus in the end of 2019. After spreading around the world, a pandemic was declared by the WHO. Depending on the different involvement of the disease, the most common symptoms are fever, cough, and dyspnea. However, some indeterminate symptoms that make diagnosis difficult, such as myalgia and fatigue, can also be seen alone, without the typical clinical picture. We describe a patient with COVID-19 pneumonia, the only complaint of which is myalgia, and the first diagnosis is mild rhabdomyolysis. The patient had no evidence or history other than viral infection that could explain muscle pain and also increased level of muscle enzymes. When mild rhabdomyolysis lack of myoglobinuria and complications was diagnosed, treatment-related rhabdomyolysis was also avoided as no treatment related to COVID-19 was initiated yet. Apart from the typical symptoms leading to the typical diagnosis of COVID-19 at the first admission, SARS-CoV-2 related with rhabdomyolysis should also be kept in mind.

Neuromuscular presentations in patients with COVID-19

“…Similarly, we identified 8 case reports (9 patients) with keywords COVID-19 and myositis/rhabdomyolysis (Table 2 ) [ 22 – 29 ].…”

“…Six patients had abnormalities on chest imaging like ground-glass opacities, pneumonia, pleural effusion, or multifocal opacities. Two patients required mechanical ventilation [22,29]. Five patients improved with conservative management.…”

“…Nine patients (age range 16 to 88 years, all males) with COVID-19-related myositis/rhabdomyolysis were reported [22][23][24][25][26][27][28][29]. Eight patients presented with generalized or limb weakness.…”

Coronavirus Disease 2019-Induced Rhabdomyolysis

“…The common causes of rhabdomyolysis are illicit drugs, alcohol, crush injuries, current medications, seizures, trauma, neuroleptic malignant syndrome, autoimmune diseases, and viral illnesses [6]. Of note, hydroxychloroquine and oseltamivir used in early COVID-19 cases have been reported to be associated with rhabdomyolysis [7]. There have been case reports about the association of rhabdomyolysis with a viral infection such as influenza and severe acute respiratory syndrome [8,9].…”

COVID-19-induced sarcopenia and physical deconditioning may require reassessment of surgical risk for patients with cancer

“…Studies of hospitalised patients have described biochemical evidence of muscle damage [16]. Several reports of severe rhabdomyolysis, even in the absence of respiratory symptoms, suggests skeletal muscle tissue is not immune from the disease process [17][18][19]. Virus-induced myositis is seen with other pathogens including SARS-CoV-1 and influenza but is unclear whether immune-mediated injury due to myotoxic cytokines (such as CXCL-10, IFN-ϒ, IL-1β, IL-6, IL-17, and TNFα) or if direct viral infiltration is the predominant pathological process.…”