Rhabdomyolysis in Pediatric Patients with SARS-CoV-2 Infection

Wu, Pingsheng; Wong, Shi-Bing; Cheng, Ching Feng; Yu, Chun-Hsien

doi:10.3390/children9101441

Cited by 5 publications

(8 citation statements)

References 32 publications

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“…Rare disease-causing mutations are associated with a small but significant subset (∼15%) of RM patients. Environmental factors such as viral infections (SARS-CoV-2, HIV), physical exertion, certain medications and drugs are major contributing factors in combination with a genetic predisposition (East, Alivizatos, Grundy, Jones, & Farmer, 1988; Knoblauch, Dagnino-Acosta, & Hamilton, 2013; Rawson, Clarkson, & Tarnopolsky, 2017; Szugye, 2020; van den Bersselaar et al, 2021; Wu, Wong, Cheng, & Yu, 2022). Even in genetic forms of RM, environmental factors increase the susceptibility to recurrent episodes of muscle breakdown (Kruijt et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Glycerolipid defects in skeletal muscle contribute to rhabdomyolysis in Tango2 deficiency

Casey

Kim

Tao

et al. 2022

Preprint

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Rhabdomyolysis is a clinical emergency characterized by severe muscle damage resulting in the release of intracellular muscle components leading to myoglobinuria and in severe cases, acute kidney failure. Rhabdomyolysis is caused by genetic factors that are linked to increased disease susceptibility in response to extrinsic triggers. Recessive mutations inTANGO2result in episodic rhabdomyolysis, metabolic crises, encephalopathy and cardiac arrhythmia, the underlying mechanism contributing to disease onset in response to specific triggers remains unclear. To address these challenges, we created a zebrafish model of Tango2 deficiency. Here we show that loss of Tango2 in zebrafish results in growth defects, early lethality and increased susceptibility of muscle defects similar toTANGO2patients. Detailed analyses of skeletal muscle revealed defects in the sarcoplasmic reticulum and mitochondria at the onset of disease development. The sarcoplasmic reticulum (SR) constitutes the primary lipid biosynthesis site and regulates calcium handling in skeletal muscle to control excitation-contraction coupling. Tango2 deficient SR exhibits increased sensitivity to calcium release that was partly restored by inhibition of Ryr1-mediated Ca2+release in skeletal muscle. Using lipidomics, we identified alterations in the glycerolipid state oftango2mutants which is critical for membrane stability and energy balance. Therefore, these studies provide insight into key disease processes in Tango2 deficiency and increased our understanding of how specific defects can predispose to environmental triggers in TANGO2-related disorders.

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Section: Introductionmentioning

confidence: 99%

Glycerolipid defects in skeletal muscle contribute to rhabdomyolysis in Tango2 deficiency

Casey

Kim

Tao

et al. 2022

Preprint

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“…Another case report of a 15-year-old male showed a CK of 22,000 U/L; however, that patient did develop AKI [8]. A small case series of eight children showed no significant morbidity and maximum CK of 7000 [5]. In all of these cases, the patients recovered with just supportive care [5][6][7][8]10].…”

Section: Discussionmentioning

confidence: 95%

“…A small case series of eight children showed no significant morbidity and maximum CK of 7000 [5]. In all of these cases, the patients recovered with just supportive care [5][6][7][8]10]. Mahajan et al described a patient who developed multiorgan failure as well as rhabdomyolysis (CK upwards of 55,000 U/L) and subsequently went on to need CRRT.…”

Section: Discussionmentioning

confidence: 99%

“…While COVID-19-associated rhabdomyolysis has been observed in the adult population, it is rarer in pediatric patients [4]. Furthermore, while COVID-19-associated rhabdomyolysis has been observed in children, it rarely causes serious life-threatening morbidity [5]. Here, we present the case of a COVID-19-positive adolescent with severe rhabdomyolysis causing critical AKI and life-threatening hyperkalemia necessitating emergent dialysis in the pediatric intensive care unit (PICU).…”

Section: Introductionmentioning

confidence: 97%

“…He completed a 10-day course with improvement in his inflammatory markers. COVID spike protein IgG and nucleocapsid IgG tests were positive, but the patient was at least 10-14 days out from initial infection and the constellation of symptoms more closely resembled active infection [5][6][7][8][9][10][11]; thus, the patient was presumed to have active COVID-19 and not MIS-C. He was able to transfer to the inpatient pediatric floor on hospital day 10 at his baseline mental status and was discharged home on hospital day 13.…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 and Severe Rhabdomyolysis Causing Acute Kidney Injury and Life-Threatening Hyperkalemia in a Pediatric Patient: a Case Report

Geeting

Alibrahim

Patel

et al. 2023

SN Compr. Clin. Med.

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Though initially believed to primarily be a respiratory pathogen, the SARS-CoV-2 virus has manifested as a virus that has the potential to affect multiple organ systems causing a wide variety of disease and symptomatology. Children have been largely spared in comparison to adult morbidity and mortality; however, acute pediatric illness secondary to COVID-19 infection has become both more common and more serious. Here, we present a teenager with acute COVID-19 who presented to the hospital with profound weakness and oliguria and was discovered to have severe rhabdomyolysis causing life-threatening hyperkalemia and acute kidney injury. He required treatment with emergent renal replacement therapy in the intensive care unit. His initial CK was 584,886 U/L. Creatinine was 14.1 mg/dL and potassium was 9.9 mmol/L. He was successfully treated with CRRT and was discharged on hospital day 13 with normal kidney function on follow-up. Rhabdomyolysis and acute kidney injury are increasingly recognized as complications of acute SARS-CoV-2 infection and require vigilance given the potentially fatal complications and long-standing morbidity associated with these conditions. Keywords Case report • Acute kidney injury • COVID-19 • Pediatric • Rhabdomyolysis • CRRTPublisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

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Rhabdomyolysis in a patient with end-stage renal disease and SARS-CoV-2 infection: A case report

Lu,

Li,

You

et al. 2023

Medicine

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Rationale: Rhabdomyolysis can be an uncommon complication of coronavirus disease 2019 (COVID-19) infection. However, the diagnosis of rhabdomyolysis could be easily missed due to its atypical clinical presentations. We present a patient with a history of end-stage renal disease (ESRD) who contracted COVID-19 and subsequently developed rhabdomyolysis. We discuss and share our experience in the management of this patient. Patient concerns: An 85-year-old male with ESRD undergoing routine hemodialysis was tested positive for COVID-19. The patient had clinical symptoms of fatigue, muscle pain, and difficulty walking. Diagnosis: The serum creatine kinase (CK) level was markedly elevated to 32,492.9U/L, supporting the diagnosis of rhabdomyolysis. A computed tomography scan revealed muscle injuries throughout the body, confirming the diagnosis. Interventions: The patient was managed through electrolyte corrections and continuous renal replacement therapy. Outcomes: Repeat tests showed decreased levels of serum CK and negative severe acute respiratory syndrome coronavirus 2. His clinical symptoms, including fatigue and muscle pain, had significantly improved. Lessons: COVID-19 infection can cause muscle pain and fatigue, which can mask the symptoms of rhabdomyolysis. A missed diagnosis of rhabdomyolysis can be severe, especially in patients with ESRD. The serum CK level should be tested with clinical suspicion. Appropriate management, including adequate hydration and electrolyte balance, should be provided. Continuous renal replacement therapy should be considered in affected patients with renal insufficiency.

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Rhabdomyolysis in Pediatric Patients with SARS-CoV-2 Infection

Cited by 5 publications

References 32 publications

Glycerolipid defects in skeletal muscle contribute to rhabdomyolysis in Tango2 deficiency

Glycerolipid defects in skeletal muscle contribute to rhabdomyolysis in Tango2 deficiency

COVID-19 and Severe Rhabdomyolysis Causing Acute Kidney Injury and Life-Threatening Hyperkalemia in a Pediatric Patient: a Case Report

Rhabdomyolysis in a patient with end-stage renal disease and SARS-CoV-2 infection: A case report

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