ABSTRACT
Introduction An 88-year-old previously independent lady presented with progressive proximal weakness of all limbs and multiple falls for 10 months. Her swallowing got difficult lately. She lost weight gradually in that duration but denied any other symptoms suggestive of malignancy. PMH—Hypothyroid, Mild cognitive impairment Drg History—Atorvastatin for years. Stopped in this admission. On examination, she showed signs of proximal muscle weakness and areflexia in both upper and lower limbs without muscle tenderness. She had no facial nor eye muscle weakness. Sensory functions were intact. There were no rashes. Investigations CK 2000 TSH 24 Inflammatory markers, white cell counts—non-significant Vitamin D—18 CT-Chest Abdomen Pelvis, CT-colonography—No evidence of malignancy Paraneoplastic antibodies—Negative Anti-OJ and anti-Ro52 Antibodies—positive ENA profile—negative Anti-RNP—equivocal HMG-CoA reductase antibodies (HMCR)—Positive. Progress Prednisolone was commenced and gradually increased to 60 mg once a day but there is no significant improvement clinically though creatinine kinase level had improved. She was unfortunately infected with COVID-19 infection in the stay which delayed the plan for muscle biopsy and EMG. It affected the plan for Intravenous Immunoglobulins and was later decided to be non-beneficial due to high risks of thromboembolic events and superimposed infections. Steroid was later switched to methotrexate. She was discharged to a rehab unit. Conclusion Necrotising Autoimmune Myopathy is a rare form of idiopathic inflammatory myopathy. Risk factors include statins, cancer, connective tissue diseases, autoimmune diseases, and infections such as HIV2. Diagnosis includes clinical features, serum creatine kinase, HMG CoA reductase antibody (HMGCR-Ab), electromyography, and muscle biopsy. The first-line treatment options are steroids and immunosuppressive agents. Early use of immunoglobulin achieves good outcome. It is still under investigation for the recommended choice for immunosuppressive therapy and the duration of the therapy.
ABSTRACT
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic outbreak has posed new problems in the context of patients suffering from other diseases. In particular, musculoskeletal sequelae related to the state of debilitation associated with COVID-19 are important to consider in elderly patients undergoing surgery after lower limbs fracture, especially in the post-operative period. The objective of this study was to evaluate whether COVID-19 influenced biochemical parameter, recovery and mortality of surgically treated patients suffering from lower extremity fractures. METHODS: Laboratory and clinical data of 30 patients were extrapolated and analyzed in the pre-operative and post-operative periods. Among these patients, 13 had COVID-19 infection (COVID-19 +), whereas 17 had no signs of COVID-19 infections (COVID-19 -). Long-term clinical and functional outcomes were also analyzed. RESULTS: Lower calcium, slightly higher values of CRP and much higher values of CPK and AST were observed pre-operatively in COVID-19 + patients, who also showed higher prevalence of long-term sequelae than COVID-19 - patients. CONCLUSIONS: COVID-19 affects long-term outcome of elderly patients with lower limb fractures in a multifactorial way. First, the virus directly damages the muscle tissue. Secondly, the lung function impairment worsens the overall performance, making rehabilitation more challenging.