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2.
Viruses ; 14(10)2022 10 14.
Article in English | MEDLINE | ID: covidwho-2071835

ABSTRACT

Rhabdomyolysis is a condition in which muscle breaks down potentially leading to renal dysfunction, and often occurs secondary to a precipitating factor. Viral or bacterial infections are common precipitants for initiating rhabdomyolysis. Recently, healthcare systems across the world have been challenged by a pandemic of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing 'coronavirus disease 2019' (COVID-19) disease. SARS-CoV-2 infection is recognized to cause respiratory and cardiovascular compromise, thromboembolic events, and acute kidney injury (AKI); however, it is not known whether it can precipitate rhabdomyolysis, with only a limited number of cases of SARS-CoV-2 infection preceding rhabdomyolysis reported to date. Here, we report the case of a 64-year-old woman who developed rhabdomyolysis shortly after SARS-CoV-2 infection and COVID-19. She initially presented with muscular pain, a creatine kinase level of 119,301 IU/L, and a mild rise in her creatinine level to 92 µmol/L, but successfully recovered with intravenous fluid support. We also review the literature to summarise previously reported cases of rhabdomyolysis precipitated by SARS-CoV-2, highlighting the need to consider this diagnosis in patients presenting with SARS-CoV-2 and myalgia.


Subject(s)
COVID-19 , Rhabdomyolysis , Humans , Female , Middle Aged , COVID-19/complications , SARS-CoV-2 , Creatinine , Rhabdomyolysis/diagnosis , Rhabdomyolysis/etiology , Myalgia/etiology , Creatine Kinase
4.
BMC Pediatr ; 22(1): 515, 2022 08 30.
Article in English | MEDLINE | ID: covidwho-2009368

ABSTRACT

BACKGROUND: Dysferlinopathy refers to a heterogenous group of autosomal recessive disorders that affect a skeletal muscle protein called dysferlin. These mutations are associated with limb-girdle muscular dystrophy type 2B, Miyoshi myopathy, asymptomatic hyperCKemia, and distal myopathy with anterior tibial onset. CASE PRESENTATION: A 16 year old female presented with myalgia, weakness and dark urine one week after her second BNT162b2 mRNA (Pfizer) vaccine. Initial serum creatine kinase (CK) was measured at 153,000 IU/L, eventually up-trending to over 200,000 IU/L. However, stable renal function precluded hemodialysis allowing discharge after 10 days of intravenous (IV) hydration and alkaline diuresis. Just two years prior to the current presentation, the patient was hospitalized following Group A Streptococcal pharyngitis infection complicated by rhabdomyolysis. She presented with fatigue, lower extremity weakness, and dark oliguria with CK measuring 984,800 IU/L. IV hydration was attempted however hemodialysis was ultimately required throughout her 24-day hospital stay. Her episode was presumed to be idiopathic and no further work-up was performed at that time. During the patient's current hospitalization, she reported similar symptomology (myalgias and weakness) following her first quadrivalent Gardasil vaccine at age 11. No hospitalization was required at that time. A comprehensive workup was now initiated while the patient was being treated for her suspected second or third non-exertional, non-traumatic rhabdomyolysis. Rheumatologic, metabolic, infectious, and endocrinologic workup were all unremarkable. Patient eventually had whole exome sequencing performed which revealed a heterozygous pathogenic variant in the DYSF gene (DYSF c.2643 + 1G > A) encoding dysferlin. No clinically significant sequelae occurred thus far. CONCLUSIONS: While there have been reports of symptomatic heterozygote carriers of dysferlinopathies, to our knowledge none have been associated with recurrent rhabdomyolysis after immunogenic stimuli. This unique case presentation highlights the importance of a multi-disciplinary care team, the utility of modern whole-exome gene sequencing, and the future challenges of balancing vaccine risk vs benefit.


Subject(s)
Muscular Dystrophies, Limb-Girdle , Rhabdomyolysis , Adolescent , BNT162 Vaccine , Child , Dysferlin/genetics , Female , Humans , Membrane Proteins/genetics , Muscular Dystrophies, Limb-Girdle/genetics , Muscular Dystrophies, Limb-Girdle/pathology , Mutation , Rhabdomyolysis/etiology
5.
Int J Mol Sci ; 23(15)2022 Jul 26.
Article in English | MEDLINE | ID: covidwho-1957350

ABSTRACT

Rhabdomyolysis is a compound disease that may be induced by many factors, both congenital and acquired. Statin therapy is considered one of the most common acquired factors. However, recent scientific reports suggest that serious complications such as rhabdomyolysis are rarely observed. Researchers suggest that, in many cases, side effects that occur with statin therapy, including muscle pain, can be avoided with lower-dose statin therapy or in combination therapy with other drugs. One of the most recent agents discovered to contribute to rhabdomyolysis is COVID-19 disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Rhabdomyolysis is defined as a damage to striated muscle cells with escape of intracellular substances into the bloodstream. These substances, including myoglobin, creatine kinase (CK), potassium, and uridine acid, are markers of muscle damage and early complications of rhabdomyolysis. Symptoms may be helpful in establishing the diagnosis. However, in almost 50% of patients, they do not occur. Therefore, the diagnosis is confirmed by serum CK levels five times higher than the upper limit of normal. One of the late complications of this condition is acute kidney injury (AKI), which is immediately life-threatening and has a high mortality rate among patients. Therefore, the prompt detection and treatment of rhabdomyolysis is important. Markers of muscle damage, such as CK, lactate dehydrogenase (LDH), myoglobin, troponins, and aspartate aminotransferase (AST), are important in diagnosis. Treatment of rhabdomyolysis is mainly based on early, aggressive fluid resuscitation. However, therapeutic interventions, such as urinary alkalinization with sodium bicarbonate or the administration of mannitol or furosemide, have not proven to be beneficial. In some patients who develop AKI in the course of rhabdomyolysis, renal replacement therapy (RRT) is required.


Subject(s)
Acute Kidney Injury , COVID-19 , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Rhabdomyolysis , Acute Kidney Injury/therapy , Biomarkers , COVID-19/complications , Creatine Kinase , Humans , Myoglobin , Rhabdomyolysis/complications , Rhabdomyolysis/diagnosis , SARS-CoV-2
7.
Ann Biol Clin (Paris) ; 80(2): 175-181, 2022 Mar 01.
Article in French | MEDLINE | ID: covidwho-1917075

ABSTRACT

Une femme de 63 ans rapporte avoir acheté une « pierre noire ¼ pour se protéger de la Covid-19 à la suite de conseils trouvés sur des réseaux sociaux. Dans les 24 heures qui suivent l'absorption d'une cuillère à soupe d'un mélange de « pierre ¼ avec du miel, apparaissent des myalgies puis une altération de l'état général qui la conduit à consulter aux urgences après 5 jours. L'examen clinique est sans autre particularité alors que le bilan biologique rapporte une insuffisance rénale aiguë et une rhabdomyolyse. L'évolution est marquée par une aggravation de l'insuffisance rénale nécessitant plusieurs séances d'hémodialyse. Les circonstances d'apparition des symptômes associées à la consommation de la « pierre ¼ font suspecter une origine toxique. Un tube de sang et la « pierre ¼ sont adressés au Laboratoire de toxicologie biologique pour analyses. La « pierre ¼ friable, noire en surface, blanche en interne, est soluble dans les alcools et peu soluble dans l'eau. L'analyse par plasma à couplage inductif - spectrométrie de masse - ne retrouve ni éléments métalliques, ni métalloïdes. L'analyse par chromatographie gazeuse couplée à la spectrométrie de masse met en évidence un pic identifié comme de la paraphénylènediamine (PPD). Une analyse par spectroscopie UV permet d'estimer la pureté de la « pierre ¼ à plus de 99 %. La PPD utilisée comme teinture capillaire noire ou adjuvant du henné est responsable d'intoxications graves, majoritairement volontaires, caractérisées par une détresse respiratoire, une rhabdomyolyse associée à des douleurs musculaires et à une insuffisance rénale. À l'exception de la détresse respiratoire, notre patiente a présenté tous les signes cliniques de l'intoxication. L'absence de détection de la PPD dans le plasma s'explique tant par la mise en œuvre de méthodes non adaptées à la détection de ce type de composés chimiques, que par le délai écoulé depuis la consommation de la « pierre ¼.


Subject(s)
COVID-19 , Rhabdomyolysis , COVID-19/epidemiology , Humans , Phenylenediamines , Social Networking , Tuberculin
9.
Am J Case Rep ; 23: e936589, 2022 Jun 20.
Article in English | MEDLINE | ID: covidwho-1903898

ABSTRACT

BACKGROUND Rhabdomyolysis is a condition in which intracellular components are released into the blood and urine. Rhabdomyolysis can be caused by drug-related complications and COVID-19; however, the underlying mechanism is not clear. In this study, we report a case of rhabdomyolysis complicated by COVID-19, in which we presumed that the cause of rhabdomyolysis was related to prior administration of haloperidol by assessment of the drug history and progression of myopathy. CASE REPORT A 52-year-old man with schizophrenia experienced worsening insomnia 10 days before admission. Thus, haloperidol was increased from 1.5 mg to 3 mg once daily, and 2 to 3 days later, he developed hand tremors and weakness. One day prior to admission, the patient suddenly developed severe back pain. Based on the examination, the patient was diagnosed with COVID-19 complicated with rhabdomyolysis. Laboratory findings on admission were as follows: creatine phosphokinase: 41 539 IU/L; urinary myoglobin, 190×10³ ng/mL; and hematuria scale, grade 4. On day 1, he was started on saline infusion; therefore, haloperidol was discontinued. On day 2, the hematuria resolved. On day 5, the tremor, weakness, and back pain had resolved. On day 7, his creatine kinase level was 242 IU/L, and saline was administered. CONCLUSIONS It has been suggested that the onset of COVID-19 can exacerbate haloperidol-induced rhabdomyolysis. Therefore, if there is a complication of rhabdomyolysis and COVID-19, it is important to review the drug history, specifically that of haloperidol. We recommend hydration and discontinuation of haloperidol to avoid acute kidney injury, in addition to treating COVID-19.


Subject(s)
Acute Kidney Injury , COVID-19 , Rhabdomyolysis , Acute Kidney Injury/etiology , Haloperidol/adverse effects , Hematuria , Humans , Male , Middle Aged , Rhabdomyolysis/etiology
10.
Am J Case Rep ; 23: e936264, 2022 Jun 03.
Article in English | MEDLINE | ID: covidwho-1897189

ABSTRACT

BACKGROUND Legionella infection is a common cause of atypical pneumonia, known as Legionnaires' disease when infection extends to extrapulmonary involvement, which often leads to hospitalization. The triad of Legionella pneumonia, rhabdomyolysis, and renal failure displays a rare yet fatal complication without prompt management. CASE REPORT Our patient was a 62-year-old man with no significant medical history who developed Legionnaires' disease with severely elevated creatinine phosphokinase (CPK) of 9614 mcg/L, consistent with rhabdomyolysis. He experienced severe headache, anorexia, and hematuria, which prompted him to seek medical care. Pertinent social history included recent flooding in his neighborhood, which surrounded the outer perimeter of his home. His clinical manifestations and laboratory findings were consistent with Legionella infection, with concomitant acute kidney injury. A chest X-ray revealed hazy left perihilar opacities concerning for atypical pneumonia. Immediate interventions of hydration and antigen-directed azithromycin were initiated to prevent rapid decompensation. His clinical symptoms resolved without further complications, and he was not transferred to the Intensive Care Unit (ICU). CONCLUSIONS Legionella-induced rhabdomyolysis is an uncommon association that can lead to acute kidney failure and rapid clinical deterioration. Early and aggressive management with fluid repletion and appropriate antibiotics can improve clinical manifestations and hospital length of stay. Our patient's reduction in CPK levels and clinical improvement confirmed that extrapulmonary involvement in Legionella infection can lead to rhabdomyolysis. It is important for healthcare providers to recognize the clinical triad of Legionella pneumonia, rhabdomyolysis, and renal failure as prompt and timely management to reduce associated morbidity.


Subject(s)
Acute Kidney Injury , Influenza, Human , Legionnaires' Disease , Pneumonia, Mycoplasma , Rhabdomyolysis , Acute Kidney Injury/complications , Acute Kidney Injury/therapy , Azithromycin , Humans , Influenza, Human/complications , Legionnaires' Disease/complications , Legionnaires' Disease/diagnosis , Legionnaires' Disease/therapy , Male , Middle Aged , Rhabdomyolysis/complications , Rhabdomyolysis/therapy
12.
Front Immunol ; 13: 845496, 2022.
Article in English | MEDLINE | ID: covidwho-1775678

ABSTRACT

Background: Severe skeletal muscle damage has been recently reported in patients with SARS-CoV-2 infection and as a rare vaccination complication. Case summary: On Apr 28, 2021 a 68-year-old man who was previously healthy presented with an extremely severe rhabdomyolysis that occurred nine days following the first dose of SARS-CoV-2 ChAdOx1 nCov-19 vaccination. He had no risk factors, and denied any further assumption of drugs except for fermented red rice, and berberine supplement. The clinical scenario was complicated by a multi organ failure involving bone marrow, liver, lung, and kidney. For the rapid increase of the inflammatory markers, a cytokine storm was suspected and multi-target biologic immunosuppressive therapy was started, consisting of steroids, anakinra, and eculizumab, which was initially successful resulting in close to normal values of creatine phosphokinase after 17 days of treatment. Unfortunately, 48 days after the vaccination an accelerated phase of deterioration, characterized by severe multi-lineage cytopenia, untreatable hypotensive shock, hypoglycemia, and dramatic increase of procalcitonin (PCT), led to patient death. Conclusion: Physicians should be aware that severe and fatal rhabdomyolysis may occur after SARS-CoV2 vaccine administration.


Subject(s)
COVID-19 , Rhabdomyolysis , Thrombocytopenia , Aged , COVID-19 Vaccines/adverse effects , ChAdOx1 nCoV-19 , Humans , Male , Multiple Organ Failure/etiology , RNA, Viral , Rhabdomyolysis/etiology , SARS-CoV-2 , Vaccination/adverse effects
13.
J Med Case Rep ; 16(1): 106, 2022 Mar 14.
Article in English | MEDLINE | ID: covidwho-1745429

ABSTRACT

BACKGROUND: Glucose-6-phosphate dehydrogenase deficiency is a rarely recognized predisposing factor for rhabdomyolysis. Rhabdomyolysis with coronavirus disease 2019 has been increasingly seen during the pandemic. We report the uncommon occurrence of coronavirus disease 2019 pneumonia, severe rhabdomyolysis, and acute renal failure in the setting of glucose-6-phosphate dehydrogenase deficiency. CASE PRESENTATION: A 19-year-old African American male presented with myalgias, diaphoresis, and dark urine. Testing for severe acute respiratory syndrome coronavirus 2 was positive. He had severe rhabdomyolysis with creatine kinase levels up to 346,695 U/L. He was oliguric and eventually required hemodialysis. Progressive hypoxemia, methemoglobinemia, and hemolytic anemia occurred following one dose of rasburicase for hyperuricemia. Glucose-6-phosphate dehydrogenase deficiency was diagnosed. Full recovery followed a single volume exchange transfusion and simple packed red blood cell transfusions. CONCLUSIONS: Glucose-6-phosphate dehydrogenase deficiency may predispose individuals to rhabdomyolysis due to severe acute respiratory syndrome coronavirus 2, presumably due to altered host responses to viral oxidative stress. Early screening for glucose-6-phosphate dehydrogenase deficiency can be useful for management of patients with rhabdomyolysis.


Subject(s)
COVID-19 , Glucosephosphate Dehydrogenase Deficiency , Methemoglobinemia , Pneumonia , Rhabdomyolysis , Adult , COVID-19/complications , Glucosephosphate Dehydrogenase Deficiency/complications , Glucosephosphate Dehydrogenase Deficiency/diagnosis , Humans , Male , Methemoglobinemia/complications , Methemoglobinemia/diagnosis , Pneumonia/complications , Rhabdomyolysis/etiology , Young Adult
15.
Am J Case Rep ; 23: e934220, 2022 Feb 23.
Article in English | MEDLINE | ID: covidwho-1707187

ABSTRACT

BACKGROUND Rhabdomyolysis is a syndrome characterized by muscle necrosis and the subsequent release of intracellular muscle constituents into the bloodstream. Although the specific cause is frequently evident from the history or from the immediate events, such as a trauma, extraordinary physical exertion, or a recent infection, sometimes there are hidden risk factors that have to be identified. For instance, individuals with sickle cell trait (SCT) have been reported to be at increased risk for rare conditions, including rhabdomyolysis. Moreover, there have been a few case reports of SARS-CoV-2 infection-related rhabdomyolysis. CASE REPORT We present a case of a patient affected by unknown SCT and admitted with SARS-CoV-2 pneumonia, who suffered non-traumatic non-exertional rhabdomyolysis leading to acute kidney injury (AKI), requiring acute hemodialysis (HD). The patients underwent 13 dialysis session, of which 12 were carried out using an HFR-Supra H dialyzer. He underwent kidney biopsy, where rhabdomyolysis injury was ascertained. No viral traces were found on kidney biopsy samples. The muscle biopsy showed the presence of an "open nucleolus" in the muscle cell, which was consistent with virus-infected cells. After 40 days in the hospital, his serum creatinine was 1.62 mg/dL and CPK and Myoglobin were 188 U/L and 168 ng/mL, respectively; therefore, the patient was discharged. CONCLUSIONS SARS-CoV-2 infection resulted in severe rhabdomyolysis with AKI requiring acute HD. Since SARS-CoV-2 infection can trigger sickle-related complications like rhabdomyolysis, the presence of SCT needs to be ascertained in African patients.


Subject(s)
Acute Kidney Injury , COVID-19 , Rhabdomyolysis , Sickle Cell Trait , Acute Kidney Injury/complications , Humans , Male , Renal Dialysis/adverse effects , Rhabdomyolysis/complications , SARS-CoV-2 , Sickle Cell Trait/complications
16.
Int J Infect Dis ; 117: 322-325, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1693386

ABSTRACT

We report a case of a Japanese man with severe rhabdomyolysis and multiple thrombosis of arterioles after the first dose of mRNA-1273 vaccine. He developed rapidly progressive rhabdomyolysis and infarctions of multiple organs. Antiplatelet factor 4 antibody test was negative. Despite the intensive supportive care, including aggressive fluid administration, hemodialysis, administration of anticoagulants, high-dose steroid, and eculizumab, the patient ultimately died of multiple organ failure. Autopsy revealed multiple thrombosis in the arterioles and organ necrosis. Low serum complements and C3 deposition in the renal glomeruli detected by immunofluorescence suggested a possible immune-mediated mechanism. To our knowledge, this is the first case report of rhabdomyolysis and multiple thrombosis of the arterioles as an adverse event following COVID-19 vaccination.


Subject(s)
COVID-19 , Rhabdomyolysis , Thrombotic Microangiopathies , 2019-nCoV Vaccine mRNA-1273 , COVID-19 Vaccines/adverse effects , Humans , Male , Rhabdomyolysis/etiology , Thrombotic Microangiopathies/etiology
17.
Am J Case Rep ; 23: e934399, 2022 Feb 17.
Article in English | MEDLINE | ID: covidwho-1689792

ABSTRACT

BACKGROUND The COVID-19 pandemic is a current global crisis, and there are hundreds of millions of individuals being vaccinated worldwide. At present, there have been few reports of COVID-19 vaccine-induced autoimmune processes manifested as myositis, thrombocytopenia, and myocarditis. CASE REPORT A 37-year-old man presented to the Emergency Department (ED) with a 3-day history of back pain and a 1-day history of left upper limb swelling with paresthesia and shortness of breath, 12-days after receiving the first dose of Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine. He was diagnosed with severe myositis complicated with rhabdomyolysis and non-oliguric acute kidney injury, thrombocytopenia, myocarditis with pulmonary edema, and pulmonary hemorrhage. Screens for potential toxic, infectious, paraneoplastic, and autoimmune disorders were unremarkable. The patient was treated with a 5-day course of intravenous methylprednisolone and intravenous immunoglobulin, with a good response. He was hospitalized for 16 days and discharged home on a tapering dose of oral prednisolone for 6 weeks. CONCLUSIONS The case describes a possible link between Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine and immune-mediated myocarditis, pulmonary vasculitis, myositis, and thrombocytopenia. However, further data are required to confirm such an association.


Subject(s)
COVID-19 , Myocarditis , Myositis , Rhabdomyolysis , Adult , COVID-19 Vaccines , Hemorrhage , Humans , Male , Myocarditis/diagnosis , Myositis/chemically induced , Pandemics , RNA, Messenger , Rhabdomyolysis/complications , SARS-CoV-2
19.
Am Surg ; 88(5): 1003-1005, 2022 May.
Article in English | MEDLINE | ID: covidwho-1582791

ABSTRACT

The novel coronavirus COVID-19 has been implicated in a number of extra-pulmonary manifestations including rhabdomyolysis. It is hypothesized to be secondary to direct muscle damage from the virus. The usual treatment of rhabdomyolysis is resuscitation with aggressive fluid management to prevent acute renal failure. However, the combination of blunt thoracic trauma and COVID pneumonia has posed additional challenges for critical care management. A 68-year-old male presented to our institution after being found down for an unknown duration of time. He was diagnosed symptomatic COVID pneumonia. His traumatic injuries included 4 rib fractures, a rectus sheath hematoma, and rhabdomyolysis with a creatinine kinase (CK) level of 16,716 U/L. He was initially treated with steroids, prone positioning, and aggressive fluid administration. Despite treatment his CK level peaked at 146,328 U/L. Here we present the case of trauma and COVID-induced rhabdomyolysis with an extremely elevated CK level.


Subject(s)
Acute Kidney Injury , COVID-19 , Rhabdomyolysis , Acute Kidney Injury/prevention & control , Aged , COVID-19/complications , Creatine Kinase , Humans , Male , Rhabdomyolysis/etiology , Rhabdomyolysis/therapy , SARS-CoV-2
20.
J Int Med Res ; 49(12): 3000605211061035, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1555662

ABSTRACT

Coronavirus disease 2019 (COVID-19) is the health crisis of our time and a great challenge we face, requiring the implementation of worldwide general containment. The symptoms and complications of COVID-19 are diverse, and rhabdomyolysis is an atypical manifestation. We report a case of a 63-year-old patient, admitted to the emergency room for myalgia and fever evolving over 5 days, in whom laboratory and other examinations indicated rhabdomyolysis complicated by renal insufficiency. During the diagnostic workup, the real-time polymerase chain reaction (RT-PCR) test result for COVID-19 was positive, revealing infection with sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the severity of COVID-19 infection relates mainly to acute respiratory syndrome, other complications can be prognostic, and these complications make the management of this disease difficult. Rhabdomyolysis is one of the fatal complications; first, because the pathophysiological mechanism is not yet understood, and second, because rhabdomyolysis, itself, is usually complicated by acute renal failure. This complication makes the disease management difficult, especially in patients with SARS. Rhabdomyolysis during COVID-19 infection represents a significant challenge, given the few reported cases, and further research is required to develop a therapeutic consensus.


Subject(s)
Acute Kidney Injury , COVID-19 , Rhabdomyolysis , Humans , Middle Aged , RNA, Viral , Rhabdomyolysis/complications , Rhabdomyolysis/diagnosis , SARS-CoV-2
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