Diagnosing SARS-CoV-2 vaccination-related rhabdomyolysis requires the exclusion of all differential causes

Abstract

Letter to the Editor,We read with interest the article by Pucchio et al. about a 16-year-old male with rhabdomyolysis that appeared a few hours after the first dose of the BNT162b2 vaccine [1]. The patient manifested clinically with severe, progressive myalgia and cola-like urine with a maximum creatine-kinase (CK) value of 147,600 U/l on hospital day 2 [1]. The patient benefited from intravenous fluids and sodium bicarbonate and made a full recovery [1]. The study is appealing but raises concerns that warrant further discussion.According to a literature review, more than the two pediatric patients with SARS-CoV-2 vaccination-associated rhabdomyolysis as described by Pucchio et al. [1] have been documented. In addition to the index patient and the 16-year-old female with rhabdomyolysis after the second BNT162b2 dose [1], several other pediatric and adult patients with SARS-CoV-2 vaccination-associated rhabdomyolysis have been noted in publications (Table 1). SARS-CoV-2 vaccination-related rhabdomyolysis was also reported in a 16-year-old female after the second BNT162b2 dose [2], in a 19-year-old male after receiving the Johnson and Johnson vaccine [3], and in a 16-yearold male after receiving the second dose of BNT162b2 (Table 1).The number of adult patients with SARS-CoV-2 vaccination-associated rhabdomyolysis is higher than presented in Table 1 of Pucchio's article [1]. More than eight adult patients have been reported. When searching Pub-Med through the end of December 2022, five pediatric and at least 13 adult cases with SARS-CoV-2-associated * Josef Finsterer