Rhabdomyolysis in Patients Hospitalized With COVID-19 Infection: Five Case Series

Abstract

The novel SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2) is now known to cause acute respiratory distress, cytokine storm, and coagulopathy. Multiple other manifestations have been published in recent literature. Rhabdomyolysis is a syndrome of muscle damage, with release of intracellular contents into circulation. It is characterized by marked elevations of creatinine kinase levels and myoglobinuria. In this article, we describe a series of 5 cases who were admitted with COVID-19 pneumonia and had severe muscle injury, as demonstrated by significant elevation (>5 times upper limit of normal) of creatinine kinase levels likely secondary to SARS-CoV-2 virus. The median age for these patients was 65 years, and most of them suffered from diabetes and hyperlipidemia. All patients were hypertensive males. Four out of 5 patients had preserved kidney function at baseline and were chronic kidney disease (CKD) stage 2 or better. However, most of them suffered significant kidney injury and at the time of discharge one patient was CKD stage 2 or better, 2 were CKD stage 3 or worse, and 2 patients had renal failure and died due to complications of SARS-CoV-2 infection.

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

“…The mechanism behind SARS-CoV2 causing rhabdomyolysis is not clear. However, viral cell invasion and cytokine-mediated direct muscle cell damage have been implicated [ 19 ]. Notably, Type II pneumocyte cytoplasm in early stages and colonic mucosa in COVID-19 patients presented with diarrhea contained the viral particles [ 19 ].…”

SARS-CoV-2 as Well as Anti-COVID-19 Treatment May Cause Rhabdomyolysis

“…1 Four patients developed renal insufficiency during hospitalization and 2 patients died. 1 It was concluded that the pathophysiology of SARS-CoV-2-associated rhabdomyolysis requires clarification. 1 The study is appealing but raises comments and concerns.…”

“…Additionally, other potential causes for renal insufficiency (eg, diabetes) were present in patients 2 to 5. 1 A second shortcoming is that the medication the 5 patients were receiving during hospitalization was not considered as a trigger of hyper-CKemia. Patient 1 received azithromycin and tocilizumab.…”

“…Patient 4 received steroids and remdesivir, and patient 5 took azithromycin. 1 Unfortunately, it is not mentioned if the 5 patients received their home medication also during hospitalization or not. Azithromycin is known to cause rhabdomyolysis in some patients.…”

“…6 A third shortcoming is that the number of patients with hyper-CKemia on admission is different between Figure 1 (3 patients) and the first paragraph of the discussion (2 patients). 1 Anyhow, no explanation for hyper-CKemia already on admission is provided, but it is conceivable that it was due to statin therapy or due to the acute infection, which presumably started already prior to admission. There are several reports showing that acute infections can trigger hyper-CKemia 7 or even rhabdomyolysis in patients regularly taking statins.…”