Myopathy associated with severe SARS-CoV-2 infection

ObjectiveMyalgia is a widely publicised feature of Covid-19, but severe muscle injury can occur. This systematic review summarises relevant evidence for skeletal muscle involvement in Covid-19. MethodsA systematic search of OVID and Medline databases was conducted on 16/3/2021 and updated on 28/10/2021 to identify case reports or observational studies relating to skeletal muscle manifestations of Covid-19 (PROSPERO: CRD42020198637). Data from rhabdomyolysis case reports were combined and summary descriptive statistics calculated. Data relating to other manifestations were analysed for narrative review.Results 1920 articles were identified. From these, 61 case reports/series met inclusion criteria, covering 86 rhabdomyolysis cases. Median age of rhabdomyolysis patients was 50 years, (range 6-89). 49% had either hypertension, diabetes mellitus or obesity. 77% were male. Symptoms included myalgia (74%), fever (69%), cough (59%), dyspnoea (68%). Median peak CK was 15,783U/L. 28% required intravenous haemofiltration and 36% underwent mechanical ventilation. 62% recovered to discharge and 30% died. Dyspnoea, elevated CRP and need for intravenous haemofiltration increased risk of fatal outcome. Additional articles relating to skeletal muscular pathologies include 6 possible concomitant diagnoses or relapses of idiopathic inflammatory myopathies and 10 reports of viral-induced muscle injuries without rhabdomyolysis. Localised myositis and rhabdomyolysis with SARS-CoV-2 vaccination have been reported. ConclusionRhabdomyolysis is an infrequent but important complication of Covid-19. Increased mortality was associated with a high CRP, renal replacement therapy and dyspnoea. The idiopathic inflammatory myopathies (IIM) may have viral environmental triggers. However, to date the limited number of case reports do not confirm an association with

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“…Several articles report cases of virally induced myositis or myopathy (89)(90)(91)(92)(93)(94)(95)(107)(108)(109). Some describe various (98).…”

Section: Viral Myositismentioning

confidence: 99%

Skeletal muscles and Covid-19: a systematic review of rhabdomyolysis and myositis in SARS-CoV-2 infection

Hannah

Ali

Nagra

et al. 2022

Clinical and Experimental Rheumatology

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“…No cases of patients with prior autoimmune history were included. Patients with history of myositis concurrent with or developed post-infection comprised 31 (78%) of these cases [ 7 , 12 , 40 - 54 ], while myositis developed in the setting of vaccination comprised nine (22%) of the cases [ 14 , 15 , 30 , 36 - 39 ]. In regard to MSA/MAA testing, 18 of the cases did not mention testing, two cases reported other specialized testing without MSAs/MAAs, and one case reported “negative immunologic tests” without definitive results.…”

Section: Discussionmentioning

confidence: 99%

“…In regard to MSA/MAA testing, 18 of the cases did not mention testing, two cases reported other specialized testing without MSAs/MAAs, and one case reported “negative immunologic tests” without definitive results. Nineteen cases reported MSA/MAA testing, 11 (61%) of which reported positivity [ 7 , 13 , 15 , 16 , 31 , 39 , 40 , 53 , 54 ], which included one anti-MDA 5 (+), two anti-SAE-1 (+), two anti-SSA (+), one anti-Ku (+) and one anti-Ku (low +), two anti-Ro-52 (+), two anti-RNP (+), two anti-Jo-1 (+), one anti-Scl-70 (+), oneanti-Sm (+), two anti-M2b (+), one anti-Pm-Scl75 (borderline +), one anti-Mi2 (+). The remaining seven (39%) cases reported MSA/MAA negativity.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Myositis-Specific Autoantibodies and Myositis-Associated Autoantibodies in COVID-19 Patients: A Pilot Study and Literature Review

Swartzman¹,

Gu²,

Toner³

et al. 2022

Cureus

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Coronavirus disease 2019 (COVID-19) infection has been linked to numerous autoimmune manifestations. Neither the mechanism nor the etiology of this association has been fully explored or elucidated. Prior studies have detected myositis in patients with proven COVID-19 infection, suggesting a relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the development of myositis. Studies have reported elevated levels of autoimmune antibodies, including myositis-specific autoantibodies (MSAs) and myositis-associated autoantibodies (MAAs), in patients with COVID-19 infection, however the prevalence is not well documented. Our objective was to assess the prevalence of MSAs and MAAs in COVID-19 patients compared with unaffected subjects. Serum samples from 74 unvaccinated, polymerase chain reaction (PCR)-positive COVID-19 infected patients were compared with serum samples from 41 healthy, unaffected individuals. All serum samples were tested for MSA and MAA reactivity. Within the COVID-19-positive group, six (8.1%) patients exhibited MSA/MAA positivity, compared with only one (2.4%) individual from the control group. Although a higher prevalence of MSA/MAA positivity was observed within the COVID-19 infected group, the difference did not reach statistical significance (p=0.223). The autoantibodies detected in this study have a unique association with dermatomyositis and other inflammatory myopathies, and may play a role in COVID-19-associated myopathy.

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“…Encephalopathy has been reported in up to 90% of ICU patients with COVID-19. 20 21 Notably, studies reporting prevalence of neurologic symptoms in critically ill patients to date have mainly been retrospective and have not controlled for severity of critical illness or amount of sedation required during mechanical ventilation. It may be that the encephalopathy seen in critical COVID-19 illness is primarily due to the unusually high amounts of sedation that have been required to achieve adequate mechanical ventilation.…”

Section: Neurologic Complications Associated With Acute Critical Covi...mentioning

confidence: 99%

Neurorecovery after Critical COVID-19 Illness

2023

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With the hundreds of millions of people worldwide who have been, and continue to be, affected by pandemic coronavirus disease (COVID-19) and its chronic sequelae, strategies to improve recovery and rehabilitation from COVID-19 are critical global public health priorities. Neurologic complications have been associated with acute COVID-19 infection, usually in the setting of critical COVID-19 illness. Neurologic complications are also a core feature of the symptom constellation of long COVID and portend poor outcomes. In this article, we review neurologic complications and their mechanisms in critical COVID-19 illness and long COVID. We focus on parallels with neurologic disease associated with non-COVID critical systemic illness. We conclude with a discussion of how recent findings can guide both neurologists working in post-acute neurologic rehabilitation facilities and policy makers who influence neurologic resource allocation.

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Myopathy associated with severe SARS-CoV-2 infection

Cited by 4 publications

References 14 publications

Skeletal muscles and Covid-19: a systematic review of rhabdomyolysis and myositis in SARS-CoV-2 infection

Skeletal muscles and Covid-19: a systematic review of rhabdomyolysis and myositis in SARS-CoV-2 infection

Prevalence of Myositis-Specific Autoantibodies and Myositis-Associated Autoantibodies in COVID-19 Patients: A Pilot Study and Literature Review

Neurorecovery after Critical COVID-19 Illness

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