Case Report: Rhabdomyolysis in a Patient with COVID-19: A Proposed Diagnostic-Therapeutic Algorithm

Solís, Juan; Pineda, Alejandra Esquivel; Alberti‐Minutti, Paolo; Sánchez, Alejandra Albarrán

doi:10.4269/ajtmh.20-0692

Cited by 22 publications

(26 citation statements)

References 21 publications

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“… 9 Regarding the beta-coronavirus family, 10% of patients with SARS and 14% of patients with Middle East respiratory syndrome (MERS) developed rhabdomyolysis, in one study. 10 …”

Section: Discussionmentioning

confidence: 99%

“…proposed an algorithm for these patients involving hydration at 400 mL/hour with saline and with a diuresis goal of >200 mL/hour or 3 mL/Kg, while considering alkalinization with bicarbonate and mannitol according to the clinical and biological progression. 10 …”

Section: Discussionmentioning

confidence: 99%

“…9 Regarding the beta-coronavirus family, 10% of patients with SARS and 14% of patients with Middle East respiratory syndrome (MERS) developed rhabdomyolysis, in one study. 10 The exact pathophysiology of muscle destruction in rhabdomyolysis is not yet well understood, but two hypotheses are discussed. The first hypothesis describes muscle necrosis secondary to direct invasion of myocytes by the virus, and the second describes myocyte toxicity secondary to CRS.…”

Section: Discussionmentioning

confidence: 99%

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SARS-CoV-2 infection presenting as rhabdomyolysis: case report and review

et al. 2021

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Coronavirus disease 2019 (COVID-19) is the health crisis of our time and a great challenge we face, requiring the implementation of worldwide general containment. The symptoms and complications of COVID-19 are diverse, and rhabdomyolysis is an atypical manifestation. We report a case of a 63-year-old patient, admitted to the emergency room for myalgia and fever evolving over 5 days, in whom laboratory and other examinations indicated rhabdomyolysis complicated by renal insufficiency. During the diagnostic workup, the real-time polymerase chain reaction (RT-PCR) test result for COVID-19 was positive, revealing infection with sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the severity of COVID-19 infection relates mainly to acute respiratory syndrome, other complications can be prognostic, and these complications make the management of this disease difficult. Rhabdomyolysis is one of the fatal complications; first, because the pathophysiological mechanism is not yet understood, and second, because rhabdomyolysis, itself, is usually complicated by acute renal failure. This complication makes the disease management difficult, especially in patients with SARS. Rhabdomyolysis during COVID-19 infection represents a significant challenge, given the few reported cases, and further research is required to develop a therapeutic consensus.

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“… 9 Regarding the beta-coronavirus family, 10% of patients with SARS and 14% of patients with Middle East respiratory syndrome (MERS) developed rhabdomyolysis, in one study. 10 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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SARS-CoV-2 infection presenting as rhabdomyolysis: case report and review

et al. 2021

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“…Bis November 2020 sind mindestens 38 Fälle einer COVID-19-assoziierten Rhabdomyolyse beschrieben worden, von denen 10 tödlich verliefen. Einschränkend muss hinzugefügt werden, dass bei einigen Patienten eine Komedikation mit möglicherweise myotoxischen Substanzen bestand, wie beispielsweise Imatinib [ 12 , 33 ], Paclitaxel [ 11 , 36 ] oder Rosuvastatin [ 1 ]. Histopathologische Untersuchungen bzw.…”

Section: Rhabdomyolyseunclassified

“…Es scheint sich somit um eine seltenere Komplikation zu handeln. Substanzen bestand, wie beispielsweise Imatinib [12,33], Paclitaxel [11,36]…”

Section: Rhabdomyolyseunclassified

Neuromuskuläre Komplikationen einer SARS-CoV-2-Infektion – Teil 2: Erkrankungen der Muskulatur

et al. 2021

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Neben Störungen und Erkrankungen peripherer Nerven sind in den letzten Monaten im Zusammenhang mit COVID-19 („coronavirus disease 2019“) auch Begleitsymptome und Störungen der Muskulatur bzw. der neuromuskulären Transmission beschrieben worden. Im zweiten Teil unserer Zusammenfassung geben wir eine Übersicht über häufig berichtete Symptome wie Myalgien und definierte Erkrankungen wie Rhabdomyolysen, Myositiden, Myasthenie und „intensive care unit acquired weakness“ (ICUAW), die im Rahmen eine SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Infektion bzw. COVID-19 beschrieben wurden. Darüber hinaus werden Kriterien für eine Kausalität wie Effektstärke, Plausibilität, Zeitverlauf und experimentelle Evidenz für einen kausalen Zusammenhang der in beiden Teilen der Übersicht beschriebenen COVID-19 assoziierten neuromuskulären Erkrankungen diskutiert. Zum jetzigen Zeitpunkt sind – neben der auch in der Laienpresse bekannten Geruchssinnstörung – vor allem Myalgien als unspezifisches Symptom häufige Folge einer symptomatischen SARS-CoV‑2 Infektion. Andere neuromuskuläre Komplikationen erscheinen hinsichtlich ihrer Pathogenese prinzipiell plausibel, aber offenbar selten Folge einer SARS-CoV-2-Infektion zu sein. Prospektive bzw. Kohortenstudien sind notwendig, um eine Kausalität zu bestätigen und das Risiko abzuschätzen.

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Imatinib

2020

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A 46-year-old man developed rhabdomyolysis during treatment with imatinib for chronic myeloid leukaemia. The man presented to the emergency room with 5-day history of respiratory illness characterised by fever, cough, generalised muscle pain and dyspnoea. He had received last dose of imatinib 3 months prior to presentation with optimal improvement [dosage and route not stated]. He denied recent use of drugs, exposure to toxins or trauma. On admission, he had tachycardia, tachypnoea and hypoxemia. Physical examination showed bilateral pulmonary rales. A chest x-ray revealed bilateral diffuse ground-glass opacities with a predominantly peripheral distribution. Laboratory tests revealed severe metabolic acidosis, thrombocytopenia, lymphopenia, increased blood levels of creatinine, LDH, creatine kinase, AST, ALT, CRP, ferritin, fibrinogen and D-dimer, and electrolyte disturbances with hyperphosphataemia, hyperkalaemia and hypocalcaemia. Urinalysis revealed dark urine, urine dipstick positive for haemoglobin, and normal sediment compatible with myoglobinuria. His urinary volume in the first 12h of admission was 20mL. These findings were consistent with grade 3 acute kidney injury (AKI). Nasopharyngeal swab was positive for COVID-19 infection by real-time reverse-transcriptase-PCR (RT-PCR). Other viral aetiology was negative. Based on these clinical presentation, he was diagnosed with severe rhabdomyolysis associated with imatinib, which resulted in AKI. The man started receiving off label treatment with azithromycin and supplemental oxygen for COVID-19 infection. He also received unspecified IV solutions and sodium bicarbonate for metabolic acidosis in AKI, but without any response. He had persistent anuria and developed uraemic encephalopathy. Thereafter, he underwent continuous renal replacement therapy with continuous veno-venous haemodiafiltration modality. On admission day 5, he developed fever and increased procalcitonin. A repeat chest x-ray findings were suggestive of disease progression or bacterial superinfection. Therefore, he was started on unspecified broad-spectrum antibiotic therapy, which was suspended after blood and sputum cultures excluded bacterial superinfection. Subsequently, he showed progressive improvement in muscle strength, pain, enzyme levels, resolution of electrolyte disturbances and stabilisation of renal function. However, he showed further impairment in respiratory condition and died during admission.

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Case Report: Rhabdomyolysis in a Patient with COVID-19: A Proposed Diagnostic-Therapeutic Algorithm

Cited by 22 publications

References 21 publications

SARS-CoV-2 infection presenting as rhabdomyolysis: case report and review

SARS-CoV-2 infection presenting as rhabdomyolysis: case report and review

Neuromuskuläre Komplikationen einer SARS-CoV-2-Infektion – Teil 2: Erkrankungen der Muskulatur

Imatinib

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