ABSTRACT
OBJECTIVE: To investigate the prevalence, describe the radiological features, and consider the clinical sequelae of COVID-19- associated shoulder girdle calcific myositis. METHODS: All patients who underwent a CT pulmonary angiogram study at our institution (Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom) in April and May 2020, January 2021, and July 2021 were included. A total of 1239 CT pulmonary angiogram studies for 1201 patients were reviewed. Patients with COVID-19 and associated shoulder girdle calcific myositis were identified. Their electronic patient records were reviewed. The patients' demographics, serum inflammatory markers, and proning history were recorded. RESULTS: Of the 364 patients in Wave 1, 71 patients (19.5%) had COVID-19, and of those, 2 patients (2.8%) had shoulder girdle calcific myositis. Of the 521 patients in Wave 2, 354 patients (67.9%) had COVID-19, and of those, 3 patients (0.8%) had shoulder girdle calcific myositis. Of the 316 patients in Wave 3, 37 patients (11.7%) had COVID-19, and of those, 1 patient (2.7%) had shoulder girdle calcific myositis. The overall prevalence was 1.3%. The most common site of calcific myositis was within the subscapularis muscle. CONCLUSION: COVID-19-associated shoulder girdle calcific myositis is a rare extrapulmonary musculoskeletal manifestation of COVID-19. Early recognition and increased awareness of this disease entity, in our experience, aids in reducing patient morbidity and improving long-term functional outcome. ADVANCES IN KNOWLEDGE: We have reported a novel disease entity associated with COVID-19, in the form of shoulder girdle calcific myositis. We have described the common imaging features and discussed our experience of management and clinical sequelae.
Subject(s)
COVID-19 , Calcinosis , Myositis , Tendinopathy , COVID-19/complications , Calcinosis/complications , Calcinosis/diagnostic imaging , Humans , Myositis/complications , Myositis/diagnostic imaging , Rotator Cuff , Shoulder , Tendinopathy/complicationsSubject(s)
COVID-19/diagnostic imaging , Creatine Kinase/metabolism , Lung/diagnostic imaging , Muscle, Skeletal/diagnostic imaging , Myositis/diagnostic imaging , Adult , Amides/therapeutic use , Antiviral Agents/therapeutic use , C-Reactive Protein/metabolism , COVID-19/diagnosis , COVID-19/metabolism , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing , Fibrin Fibrinogen Degradation Products/metabolism , Glucocorticoids/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Lymphopenia/diagnosis , Magnetic Resonance Imaging , Male , Methylprednisolone/therapeutic use , Myositis/metabolism , Myositis/physiopathology , Pyrazines/therapeutic use , SARS-CoV-2 , Tomography, X-Ray ComputedABSTRACT
Myalgia is a previously reported symptom in patients with COVID-19 infection; however, the presence of paraspinal myositis has not been previously reported. We report MR imaging findings of the spine obtained in a cohort of 9 patients with COVID-19 infection who presented to our hospital between March 3, 2020 and May 6, 2020. We found that 7 of 9 COVID-19 patients (78%) who underwent MR imaging of the spine had MR imaging evidence of paraspinal myositis, characterized by intramuscular edema and/or enhancement. Five of these 7 patients had a prolonged hospital course (greater than 25 days). Our knowledge of the imaging manifestations of COVID-19 infection is expanding. It is important for clinicians>a to be aware of the relatively high frequency of paraspinal myositis in this small cohort of patients with COVID-19 infection.