Rhabdomyolysis in a Patient With Coronavirus Disease 2019

Abstract

Coronavirus disease 2019 has rapidly enveloped the world in a pandemic after emerging in Wuhan, China, in December 2019. We describe a 49-year-old man presenting with fever, cough, dyspnea, and myalgia diagnosed with coronavirus disease 2019 along with rhabdomyolysis and acute kidney injury. The creatine phosphokinase was elevated to 23,800 U/L before trending down to normal levels. Rapid identification and treatment with aggressive intravenous hydration and correction of electrolyte abnormalities remain key to successful management. In a pandemic, often atypical presentations of this new disease have to be considered as differentials for early diagnosis and treatment of life-threatening conditions.

COVID-19 Presenting as Severe Rhabdomyolysis With Normal Renal Function

“…In three of these cases, with COVID-19 associated rhabdomyolysis, the patients were above 65 years of age and also developed acute kidney injury (AKI) with elevated creatinine [3,4,6]. For the other two cases, the patients were below 50 years of age, but had an associated AKI [5,7]. There was one case of a 38-year-old male with COVID-19 associated rhabdomyolysis with normal renal function, however, his peak CK was only 42,670 U/L [8].…”

“…During the literature review, we found a few reported cases of COVID-19 associated rhabdomyolysis in adults [2][3][4][5][6][7][8]. In three of these cases, with COVID-19 associated rhabdomyolysis, the patients were above 65 years of age and also developed acute kidney injury (AKI) with elevated creatinine [3,4,6].…”

“…An atypical presentation can be a diagnostic challenge. Currently, there have been few reported cases of COVID-19 associated rhabdomyolysis in adults and few in pediatrics [2][3][4][5][6][7][8][9][10]. Here, we report the first case of COVID-19 presenting as severe rhabdomyolysis with creatine kinase > 500,000 U/L with normal renal function in a young adult.…”

Development of acute kidney injury with massive granular casts and microscopic hematuria in patients with COVID-19: two case presentations with literature review

“…All patients were male. Among the five patients, three developed AKI [20,21,24] and one of three patients received renal replacement therapy [24]. Different pathogeneses of rhabdomyolysis have been suggested; these include direct invasion of the muscle by virus, cytokine storm resulting in muscle damage, and muscle injury by circulating viral toxins [23].…”

Fatal Rhabdomyolysis in a COVID-19 Patient on Rosuvastatin

“…We are seven months into the COVID-19 pandemic, and the full neuromuscular manifestation has yet to be understood. Rhabdomyolysis from COVID-19 infection has been described [ 1 - 4 ] but is largely non-fatal. Most reported creatinine kinase (CK) levels are only mildly elevated - less than five digits.…”