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

Abstract

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

Rhabdomyolysis-Induced AKI (RIAKI) Including the Role of COVID-19

“…Ramos-Casals et al [ 18 ] point out that there are differences in the characteristics of clinical symptoms depending on age, gender or ethnicity. This is supported by the observations of Hannah et al [ 19 ], who note that of patients with rhabdomyolysis in COVID-19, as many as 77% are male. They also point out that comorbidities, such as arterial hypertension, obesity, and diabetes mellitus, increase the risk of rhabdomyolysis in the course of COVID-19.…”

“…Despite the fact that COVID-19 manifests primarily with respiratory symptoms, it can also produce extrapulmonary symptoms [ 18 ]. One of these is myalgia, which is a common symptom of COVID-19, and is estimated to occur in 19–33% of patients [ 19 ]. Muscle symptoms include myositis, which is shown in Figure 3 [ 18 ].…”

“…However, it can result in life-threatening consequences. In a report by Hannah et al [ 19 ], slightly more than half of patients with rhabdomyolysis developed AKI. In addition, multiple organ failure or death are possible complications.…”

“…Some investigators have implicated excessive immune response in the causes of muscle damage during SARS-CoV-2 infection [ 13 , 18 ]. Others point to direct damage caused by the virus or involving immune factors [ 19 ]. Acute kidney injury (AKI) is also a common complication of COVID-19 [ 20 , 21 , 22 ].…”

Anti-MDA5 Antibody Linking COVID-19, Type I Interferon, and Autoimmunity: A Case Report and Systematic Literature Review

“…Through the recognition of viral dsRNA and the activation of a type I IFN response, MDA5 could link SARS-CoV-2 infection and subsequent anti-MDA5 syndrome ( 50 ). In our case, overt anti-MDA5 syndrome was preceded by a mild (flu-like) form of SARS-CoV-2 infection.…”