Anaphylaxis and Rhabdomyolysis: A Presentation of a Pediatric Patient With COVID-19

COVID-19 vaccine induced rhabdomyolysis: Case report with literature review

“…Several case reports have discussed incidences of rhabdomyolysis with COVID-19 and its implications as summarized in Table 2 [ 19 , 20 , [22] , [23] , [24] , [25] , [26] , [27] ]. Unfortunately, rhabdomyolysis with its symptoms such as fever, myalgia, and signs (elevated liver enzymes and lactate dehydrogenase) is similar to COVID-19 itself and may go unrecognized [ 22 ].…”

“…Two independent risk factors for in-hospital deaths were creatine kinase (CK) levels greater than 1000 IU/L and serum myoglobin levels greater than 1000 ng/ml [ 28 ]. However, Bach et al clarify that while both CK and myoglobin levels are monitored, Myoglobin levels are less useful in diagnosing rhabdomyolysis due to increased false-negative results, caused by myoglobin's short half-life [ 23 ]. However, this suggests the need for CK monitoring in all SARS-CoV2 patients to screen for rhabdomyolysis.…”

“…History Clinical Presentation Peak CK (U/L) AST/ALT (U/L) Peak. Cr (mg/dL) LDH (U/L) Myotoxic Drug Use Outcome Alrubaye [ 22 ] 35 F None Myalgia, Fever, Cough, Diarrhea 71,000 1900/450 .82 401 No Survived, Discharged Day 4 Bach [ 23 ] Adol-les -cent M Obesity Myalgia, Anosmia,M Loss of Appetite, Recurrent Anaphylaxis 174,300 NR .82 NR No Survived, Discharged Day 9 Buckholz [ 24 ]Patient1 43 M None Myalgia, Cough, Fever 75,240 1474/NR 13.35 NR NR Survived Buckholz [ 24 ]Patient2 37 M None Myalgia, SOB, fever 82,960 902/NR 1.47 NR NR Survived Buckholz [ 24 ]Patient3 75 M Deep Vein Thromb-osis Rhinorrhea Back pain, Weakness 3636 56/NR 1.78 …”

Rhabdomyolysis and coronavirus disease‐2019 in children: A case report and review of the literature

“…Possible mechanisms of rhabdomyolysis in SARS‐CoV‐2 infection include direct viral destruction of the muscle cells or collateral muscle damage precipitated by an excessive immune response. 6 , 9 Dalakas describes that SARS‐CoV‐2 connects to the angiotensin‐converting enzyme 2 receptor, which is expressed in skeletal muscle cells and leads to down‐regulation of renin‐angiotensin, directly changing muscle integrity. 17 Interestingly, a recent case report of a child with severe rhabdomyolysis associated with MIS‐C has demonstrated clinical improvement after IVIG suggesting an immune‐mediated mechanism comparable to the pathogenesis of necrotizing autoimmune myositis described in up to 10% of adults with COVID‐19 infection.…”

A Comprehensive Review of Neuromuscular Manifestations of COVID-19 and Management of Pre-Existing Neuromuscular Disorders in Children

“…There have been numerous reports of COVID-19-associated rhabdomyolysis in pediatric patients [14,[20][21][22][23][24][25][26][27][28][29] leading to acute kidney injury or acute renal failure [20,23,[27][28][29]. In some cases, rhabdomyolysis was the presenting symptom [26,29].…”