Severe rhabdomyolysis secondary to COVID-19 mRNA vaccine in a teenager

Abstract

Background Rhabdomyolysis, the breakdown of skeletal muscles following an insult or injury, has been established as a possible complication of SARS-CoV-2 infection. Despite being highly effective in preventing COVID-19-related morbidity and mortality, several cases of COVID-19 mRNA vaccination-induced rhabdomyolysis have been identified. We provide the second description of a pediatric case of severe rhabdomyolysis presenting after COVID-19 mRNA vaccination. Case: diagnosis/treatment A 16-year-old male reported to the emergency department with a 2-day history of bilateral upper extremity myalgias and dark urine 2 days after his first dose of COVID-19 vaccine (Pfizer-BioNtech). The initial blood work showed an elevated creatinine kinase (CK) of 141,300 units/L and a normal creatinine of 69 umol/L. The urinalysis was suggestive of myoglobinuria, with the microscopy revealing blood but no red blood cells. Rhabdomyolysis was diagnosed, and the patient was admitted for intravenous hydration, alkalinization of urine, and monitoring of kidney function. CK levels declined with supportive care, while his kidney function remained normal, and no electrolyte abnormalities developed. The patient was discharged 5 days after admission as his symptoms resolved. Conclusion While vaccination is the safest and most effective way to prevent morbidity from COVID-19, clinicians should be aware that rhabdomyolysis could be a rare but treatable adverse event of COVID-19 mRNA vaccination. With early recognition and diagnosis and supportive management, rhabdomyolysis has an excellent prognosis.

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

“…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.…”

“…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.…”

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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].

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“…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.…”

“…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).…”