Clinical, electromyographical, histopathological characteristics of COVID-19 related rhabdomyolysis

Abstract

Rhabdomyolysis is an uncommon complication of the coronavirus disease 2019 (COVID-19) infection. Previous reports have described its management and treatment in medical units, but have not discussed confirmatory tests or differential diagnosis. We report a case of a 58 year-old male patient, who was admitted for COVID-19 pneumonia and subsequently developed severe weakness, inability to move limbs, acute renal failure, significantly elevated myoglobin and creatinine kinase, and was diagnosed with rhabdomyolysis. Continuous renal replacement therapy, the treatment modality of choice over hyperhydration due to ongoing mechanical ventilation, was effective in resolving symptoms. No direct viral invasion of muscles was noted on biopsy. Here, we describe his symptoms, electromyography, and muscular biopsy results, and further discuss the possible differential diagnoses. Neuromuscular symptoms related to COVID-19 require careful clinical analysis. In addition, detailed reports of patients’ course of illness and diagnoses will assist in improving care for affected patients.

Skeletal Muscle Damage in COVID-19: A Call for Action

“…In that patient, motor and sensory fiber injuries (axonal injury accompanied by demyelination) in both legs were detected by electromyography after 120 days [43]. In another study, electromyography revealed a decrease in compound muscle action potential of the motor nerves despite normal nerve conduction in a 58-years old male COVID-19 patient with rhabdomyolysis [20]. Such reports highlight the possibility that COVID-19-related muscular injury may cause long-term disabilities.…”

“…In rare cases, viral-induced myotoxicity was reported [13]. Renal injury noted by macrohematuria or even renal failure is reported along with myalgia in COVID-19 patients with rhabdomyolysis, denoting a possible renal involvement in COVID-19-related muscle damage [13,20]. Symptoms conducive to malnutrition, such as anorexia, nausea, and vomiting, are common in some COVID-19 patients pinpointing insufficient energy supply-a primary trigger for the breakdown of body protein to fuel metabolic needs [21][22][23][24][25][26].…”

The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection

“…Additionally, it has been well documented case reports of COVID-19 related rhabdomyolysis ( Alrubaye and Choudhary, 2020 ; Chan et al, 2020 ; Husain et al, 2020 ; Khosla et al, 2020 ; Meegada et al, 2020 ; Mukherjee et al, 2020 ; Rivas-García et al, 2020 ; Rosato et al, 2020 ; Singh et al, 2020 ; Byler et al, 2021 ; Haroun et al, 2021 ; Mah et al, 2021 ; Patel et al, 2021 ). Rhabdomyolysis is a skeletal muscle injury that can result in acute kidney injury, a life-threatening clinical complication.…”

“…The case reports and original articles comprised only individuals who were treated in intensive care units (ICU) or received sub-intensive or intermediate care, normally with ventilator support during the diseases’ course. Usually, these studies report the visible muscle wasting of the hospitalized patients ( Andrade-Junior et al, 2021 ; Giraudo et al, 2021 ; Kumar et al, 2021 ), as well as musculoskeletal complications such as rhabdomyolysis ( Alrubaye and Choudhary, 2020 ; Zhang Q. et al, 2020 ; Chan et al, 2020 ; Khosla et al, 2020 ; Solís et al, 2020 ; Byler et al, 2021 ; Haroun et al, 2021 ), myalgia ( Mukherjee et al, 2020 ; Uçaroğlu Can et al, 2020 ; Batur et al, 2021 ; De Rosa et al, 2021 ; Vasiliadis et al, 2021 ), cachexia ( Anker et al, 2021 ), critical illness myopathy ( Cabañes-Martínez et al, 2020 ; Islam et al, 2021 ), generalized weakness ( Chan et al, 2020 ; Rosato et al, 2020 ; Paneroni et al, 2021 ), and increased levels of serum CK ( Chan et al, 2020 ; Khosla et al, 2020 ; Batur et al, 2021 ; Byler et al, 2021 ; De Rosa et al, 2021 ; Haroun et al, 2021 ; Orsucci et al, 2021 ; Pitscheider et al, 2021 ).…”

Acute neuromuscular syndromes with respiratory failure during COVID-19 pandemic: Where we stand and challenges ahead

“…Gupta et al [93] stated that the dermatomyositis is the most frequent subtype (40%) of inflammatory myopathies, attributable to COVID-19 pandemic; Mehan et al [94] described 7 patients with paraspinal myositis and 4 were intubated over their hospital stay. Rosato et al [95] reviewed 16 case reports from existing literature and discussed the COVID-19 -related rhabdomyolysis in one patient who developed acute muscle weakness, renal failure, hypoxia.Table 3 shows adult cases of acute myopathies with respiratory failure with or without rhabdomyolysis during COVID-19 pandemic.…”