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1.
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 , Humans , Male , Multiple Organ Failure/etiology , RNA, Viral , Rhabdomyolysis/etiology , SARS-CoV-2 , Vaccination/adverse effects
2.
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
3.
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 , COVID-19 Vaccines/adverse effects , Humans , Male , Rhabdomyolysis/etiology , Thrombotic Microangiopathies/etiology
4.
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
5.
J Med Case Rep ; 15(1): 576, 2021 Dec 02.
Article in English | MEDLINE | ID: covidwho-1551232

ABSTRACT

BACKGROUND: Rhabdomyolysis is defined as a syndrome consisting of muscle necrosis and the release of intracellular muscle components into the bloodstream. Although rhabdomyolysis has been previously reported as an initial presentation or late complication of COVID-19, the data on it is still limited, and currently, there is no single case of COVID-19 in the literature that describes creatine kinase levels of more than 30,000 IU/L. CASE PRESENTATION: A 50-year-old African-American male presented to the hospital with decreased urine output, dark urine color, and constipation for the past couple of days. He was found to have acute kidney injury, liver injury, and creatinine kinase of 359,910 IU/L, for which aggressive intravenous fluid therapy was given. Infectious workup resulted in positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction. Two days after admission, the patient became symptomatic from a coronavirus disease 2019: he developed fever and hypoxia, and was placed on supplemental oxygen and started on a 10-day course of dexamethasone. The patient responded well to the treatment and supportive care for coronavirus disease 2019 and was successfully discharged. CONCLUSION: Clinicians should be cognizant of atypical coronavirus disease 2019 presentations. The spectrum of damage of coronavirus disease 2019 is still an evolving topic, and more research is required to reveal the exact mechanisms by which severe acute respiratory syndrome coronavirus 2 leads to rhabdomyolysis.


Subject(s)
Acute Kidney Injury , COVID-19 , Rhabdomyolysis , Acute Kidney Injury/etiology , Creatinine , Humans , Male , Middle Aged , Rhabdomyolysis/diagnosis , Rhabdomyolysis/etiology , SARS-CoV-2
8.
J Surg Res ; 266: 35-43, 2021 10.
Article in English | MEDLINE | ID: covidwho-1349537

ABSTRACT

BACKGROUND: Bedside experience and studies of critically ill patients with coronavirus disease 2019 (COVID-19) indicate COVID-19 to be a devastating multisystem disease. We aim to describe the incidence, associated variables, and outcomes of rhabdomyolysis in critically ill COVID-19 patients. MATERIALS AND METHODS: Data for all critically ill adult patients (≥18 years old) admitted to the ICU at a large academic medical center with confirmed COVID-19 between March 13, 2020 and April 18, 2020 were prospectively collected. Patients with serum creatine kinase (CK) concentrations greater than 1000 U/L were diagnosed with rhabdomyolysis. Patients were further stratified as having moderate (serum CK concentration 1000-4999 U/L) or severe (serum CK concentration ≥5000 U/L) rhabdomyolysis. Univariate and multivariate analyses were performed to identify outcomes and variables associated with the development of rhabdomyolysis. RESULTS: Of 235 critically ill COVID-19 patients, 114 (48.5%) met diagnostic criteria for rhabdomyolysis. Patients with rhabdomyolysis more often required mechanical ventilation (P < 0.001), prone positioning (P < 0.001), pharmacological paralysis (P < 0.001), renal replacement therapy (P = 0.010), and extracorporeal membrane oxygenation (ECMO) (P = 0.025). They also had longer median ICU length of stay (LOS) (P < 0.001) and hospital LOS (P < 0.001). No difference in mortality was observed. Male sex, patients with morbid obesity, SOFA score, and prone positioning were independently associated with rhabdomyolysis. CONCLUSIONS: Nearly half of critically ill COVID-19 patients in our cohort met diagnostic criteria for rhabdomyolysis. Male sex, morbid obesity, SOFA score, and prone position were independently associated with rhabdomyolysis.


Subject(s)
COVID-19/complications , Obesity, Morbid/epidemiology , Rhabdomyolysis/epidemiology , Aged , Body Mass Index , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Comorbidity , Creatine Kinase/blood , Critical Illness , Female , Hospital Mortality , Humans , Incidence , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Obesity, Morbid/complications , Obesity, Morbid/diagnosis , Organ Dysfunction Scores , Prone Position , Prospective Studies , Rhabdomyolysis/blood , Rhabdomyolysis/diagnosis , Rhabdomyolysis/etiology , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/isolation & purification , Sex Factors
9.
Curr Rheumatol Rep ; 23(8): 63, 2021 07 03.
Article in English | MEDLINE | ID: covidwho-1293439

ABSTRACT

PURPOSE: Myositis as a rare manifestation of COVID-19 is only recently being reported. This review examines the current literature on COVID-19-induced myositis focusing on etiopathogenesis, clinical presentations, diagnostic practices, and therapeutic challenges with immunosuppression, and the difficulties experienced by rheumatologists in established myositis in the COVID-19 era. RECENT FINDINGS: COVID-19 is associated with a viral myositis attributable to direct myocyte invasion or induction of autoimmunity. COVID-19-induced myositis may be varied in presentation, from typical dermatomyositis to rhabdomyolysis, and a paraspinal affliction with back pain. It may or may not present with acute exponential elevations of enzyme markers such as creatine kinase (CK). Virus-mediated muscle inflammation is attributed to ACE2 (angiotensin-converting enzyme) receptor-mediated direct entry and affliction of muscle fibers, leading on to innate and adaptive immune activation. A greater recognition of the stark similarity between anti-MDA5-positive myositis with COVID-19 has thrown researchers into the alley of exploration - finding common etiopathogenic basis as well as therapeutic strategies. For patients with established myositis, chronic care was disrupted during the pandemic with several logistic challenges and treatment dilemmas leading to high flare rates. Teleconsultation bridged the gap while ushering in an era of patient-led care with the digital transition to tools of remote disease assessment. COVID-19 has brought along greater insight into unique manifestations of COVID-19-related myositis, ranging from direct virus-induced muscle disease to triggered autoimmunity and other etiopathogenic links to explore. A remarkable shift in the means of delivering chronic care has led patients and caregivers worldwide to embrace a virtual shift with teleconsultation and opened doorways to a new era of patient-led care.


Subject(s)
COVID-19/physiopathology , Myositis/physiopathology , Rhabdomyolysis/physiopathology , Adaptive Immunity/immunology , Angiotensin-Converting Enzyme 2/metabolism , Autoantibodies/immunology , Back Pain/etiology , COVID-19/complications , COVID-19/immunology , COVID-19/metabolism , Creatine Kinase/metabolism , Dermatomyositis/etiology , Dermatomyositis/immunology , Dermatomyositis/metabolism , Dermatomyositis/physiopathology , Humans , Immunity, Innate/immunology , Interferon-Induced Helicase, IFIH1/immunology , Myasthenia Gravis/etiology , Myasthenia Gravis/immunology , Myasthenia Gravis/metabolism , Myasthenia Gravis/physiopathology , Myositis/etiology , Myositis/immunology , Myositis/metabolism , Paraspinal Muscles/physiopathology , Receptors, Coronavirus/metabolism , Rhabdomyolysis/etiology , Rhabdomyolysis/immunology , Rhabdomyolysis/metabolism , SARS-CoV-2
10.
Int J Mol Sci ; 22(13)2021 Jun 30.
Article in English | MEDLINE | ID: covidwho-1288908

ABSTRACT

The continually evolving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in a vast number of either acute or chronic medical impairments of a pathophysiology that is not yet fully understood. SARS-CoV-2 tropism for the organs is associated with bilateral organ cross-talks as well as targeted dysfunctions, among which acute kidney injury (AKI) seems to be highly prevalent in infected patients. The need for efficient management of COVID-related AKI patients is an aspect that is still being investigated by nephrologists; however, another reason for concern is a disturbingly high proportion of various types of kidney dysfunctions in patients who have recovered from COVID-19. Even though the clinical picture of AKI and COVID-related AKI seems to be quite similar, it must be considered that regarding the latter, little is known about both the optimal management and long-term consequences. These discrepancies raise an urgent need for further research aimed at evaluating the molecular mechanisms associated with SARS-CoV-2-induced kidney damage as well as standardized management of COVID-related AKI patients. The following review presents a comprehensive and most-recent insight into the pathophysiology, clinical manifestations, recommended patient management, treatment strategies, and post-mortem findings in patients with COVID-related AKI.


Subject(s)
Acute Kidney Injury/diagnosis , COVID-19/pathology , Acute Kidney Injury/etiology , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Biomarkers/metabolism , COVID-19/complications , COVID-19/drug therapy , COVID-19/virology , Glomerular Filtration Rate , Humans , Interleukin-6/metabolism , Renin-Angiotensin System , Rhabdomyolysis/etiology , SARS-CoV-2/isolation & purification
11.
BMJ Case Rep ; 14(5)2021 May 24.
Article in English | MEDLINE | ID: covidwho-1242195

ABSTRACT

We report a case of severe hypercalcaemia secondary to rhabdomyolysis in a woman with COVID-19 (SARS CoV-2) infection. The patient presented with myalgia and anuria with an acute kidney injury requiring haemodialysis. Creatine kinase peaked at 760 000 IU/L. A biphasic calcaemic response was observed with initial severe hypocalcaemia followed by severe, symptomatic hypercalcaemia, persistent despite haemodialysis. Control of the calcium levels was achieved by continuous haemofiltration.


Subject(s)
Acute Kidney Injury , COVID-19 , Rhabdomyolysis , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Calcium , Female , Homeostasis , Humans , Rhabdomyolysis/etiology , SARS-CoV-2
14.
J Prim Care Community Health ; 12: 21501327211005294, 2021.
Article in English | MEDLINE | ID: covidwho-1148207
15.
Turk J Med Sci ; 51(3): 1598-1601, 2021 06 28.
Article in English | MEDLINE | ID: covidwho-1081584

ABSTRACT

Background/aim: This mini-review aims at summarising and discussing previous and recent findings concerning the clinical manifestations, therapeutic management, and outcome of SARS-CoV-2 associated rhabdomyolysis. Materials and methods: Literature search in the PubMed database by applying appropriate search terms. Results: A total of 26 articles reporting SARS-CoV-2 associated rhabdomyolysis in 32 patients were identified. Age ranged from 16 to 80 years. Four patients were female and 25 were male. Onset of rhabdomyolysis was prior to onset of COVID-19 in 7 patients, and after onset of COVID-19 in the remaining patients. Exposure to myotoxic medication was identified in 18 patients. Myotoxic drugs these patients were taking at the time rhabdomyolysis included azithromycin, hydroxy-chloroquine, placitaxel, propofol, imastinib, piperacillin and meropenem, hydrochlorothiazide, and acetaminophen. Peak creatine-kinase values ranged from 328 to >427656 U/l. The outcome was unreported in 8 cases, favourable in 15 partial, incomplete in 3 cases, and lethal in 6 cases. Conclusion: SARS-CoV-2 associated rhabdomyolysis is rare, may be most frequently due to the side effects of myotoxic anti-COVID-19 drugs, and only rarely due to virus myositis, and may have a favourable outcome in most patients.


Subject(s)
COVID-19 , Rhabdomyolysis/etiology , SARS-CoV-2 , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/blood , COVID-19/drug therapy , COVID-19/virology , Creatine Kinase/blood , Drug-Related Side Effects and Adverse Reactions , Female , Humans , Male , Middle Aged , Young Adult
16.
Seizure ; 84: 66-68, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1065590

ABSTRACT

Symptoms of COVID-19, as reported during the SARS-CoV-2 pandemic in 2019-2020, are primarily respiratory and gastrointestinal, with sparse reports on neurological manifestations. We describe the case of a 17-year old female with Cornelia de Lange syndrome and well controlled epilepsy, who sustained significant cortical injury during a COVID-19 associated multi-inflammatory syndrome.


Subject(s)
Brain Diseases/physiopathology , COVID-19/physiopathology , De Lange Syndrome/complications , Epilepsy/physiopathology , Seizures/physiopathology , Systemic Inflammatory Response Syndrome/physiopathology , Acute Kidney Injury/etiology , Adolescent , Airway Extubation , Anticonvulsants/therapeutic use , Blood Coagulation Disorders/etiology , Bone Marrow Failure Disorders , Brain Diseases/diagnostic imaging , Brain Diseases/etiology , Brain Diseases/pathology , Brain Edema/diagnostic imaging , Brain Edema/etiology , C-Reactive Protein/immunology , COVID-19/complications , COVID-19/immunology , COVID-19/therapy , Disease Progression , Electroencephalography , Epilepsy/complications , Epilepsy/drug therapy , Female , Ferritins/metabolism , Humans , Influenza B virus , Influenza, Human/complications , Levetiracetam/therapeutic use , Magnetic Resonance Imaging , Midazolam/therapeutic use , Necrosis , Phenobarbital/therapeutic use , Pseudomonas Infections/complications , Respiration, Artificial , Rhabdomyolysis/complications , Rhabdomyolysis/etiology , SARS-CoV-2 , Seizures/drug therapy , Seizures/etiology , Sepsis/etiology , Sepsis/physiopathology , Sepsis/therapy , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/immunology , Systemic Inflammatory Response Syndrome/therapy , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/physiopathology , Tachycardia, Ventricular/therapy
17.
Chest ; 158(6): e267-e268, 2020 12.
Article in English | MEDLINE | ID: covidwho-860852

ABSTRACT

Systemic capillary leak syndrome is a rare disorder characterized by dysfunctional inflammatory response, endothelial dysfunction, and extravasation of fluid from the vascular space to the interstitial space leading to shock, hemoconcentration, hypoalbuminemia, and subsequent organ failure. The condition may be idiopathic or secondary to an underlying cause, which can include viral infections. Here we describe a patient with acute coronavirus disease 2019 (COVID-19) infection who presented with hemoconcentration, shock, and hypoalbuminemia. The patient subsequently developed rhabdomyolysis and compartment syndrome of all four extremities, requiring fasciotomies. This is the first reported case of systemic capillary leak syndrome associated with COVID-19 infection. This case adds to the evolving spectrum of inflammatory effects associated with this viral infection.


Subject(s)
COVID-19/physiopathology , Capillary Leak Syndrome/physiopathology , Compartment Syndromes/physiopathology , Hypoalbuminemia/physiopathology , Shock/physiopathology , Abdominal Pain/etiology , Acidosis, Lactic/etiology , Acidosis, Lactic/physiopathology , Acidosis, Lactic/therapy , Acute Kidney Injury/etiology , Acute Kidney Injury/physiopathology , Acute Kidney Injury/therapy , COVID-19/complications , COVID-19/therapy , Capillary Leak Syndrome/etiology , Compartment Syndromes/etiology , Compartment Syndromes/surgery , Continuous Renal Replacement Therapy , Crystalloid Solutions/therapeutic use , Edema/etiology , Edema/physiopathology , Fasciotomy , Fatal Outcome , Fluid Therapy , Hematocrit , Humans , Hypoalbuminemia/etiology , Hypoalbuminemia/therapy , Male , Middle Aged , Respiration, Artificial , Rhabdomyolysis/etiology , Rhabdomyolysis/physiopathology , Shock/etiology , Shock/therapy , Tomography, X-Ray Computed , Vasoconstrictor Agents/therapeutic use
18.
Am J Trop Med Hyg ; 103(3): 1158-1161, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-854397

ABSTRACT

COVID-19 represents the greatest health challenge of modern years. The spectrum of illness comprises respiratory and non-respiratory manifestations. We report the case of an adult man with COVID-19 who presented with rhabdomyolysis as a principal extrapulmonary manifestation. Our patient presented with dyspnea, fever, and muscle pain. After a comprehensive approach, the diagnosis of COVID-19 and rhabdomyolysis was made. He developed acute kidney injury requiring renal replacement therapy without reversibility, despite optimal treatment. We performed a literature search for similar cases, discuss the potential mechanisms implied, and propose a diagnostic-therapeutic algorithm.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Pneumonia, Viral/complications , Rhabdomyolysis/etiology , Acute Kidney Injury/etiology , Algorithms , COVID-19 , Coronavirus Infections/diagnostic imaging , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnostic imaging , Rhabdomyolysis/diagnosis , Rhabdomyolysis/therapy , SARS-CoV-2
19.
Pediatrics ; 147(3)2021 03.
Article in English | MEDLINE | ID: covidwho-839707

ABSTRACT

The novel coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, has created a global pandemic, with many cases affecting the elderly. However, children have been affected as well, with ∼2.4% to 3.7% of cases reported. This case is the first published case of an adolescent presenting with rhabdomyolysis as the first sign of novel coronavirus disease 2019, with extremely elevated creatinine kinase levels, approaching almost 400 000 U/L. This case adds to the growing body of literature of a variety of life-threatening manifestations associated with severe acute respiratory syndrome coronavirus 2 infection and highlights the importance of how prompt recognition of these unique presentations of the disease is important to mitigate complications.


Subject(s)
COVID-19/complications , COVID-19/diagnosis , Rhabdomyolysis/etiology , Adolescent , Biomarkers/blood , Biomarkers/urine , COVID-19/therapy , Creatine Kinase/urine , Critical Care , Humans , Male , Pandemics , Rhabdomyolysis/diagnosis , Rhabdomyolysis/virology , SARS-CoV-2
20.
Pediatr Infect Dis J ; 39(10): e314-e315, 2020 10.
Article in English | MEDLINE | ID: covidwho-766880

ABSTRACT

Severe acute respiratory syndrome coronavirus 2, the virus responsible of the current COVID-19 pandemic, has limited impact in the pediatric population. Children are often asymptomatic or present mild flu-like symptoms. We report the case of a COVID-19-infected adolescent presenting severe rhabdomyolysis and acute kidney injury without any fever or respiratory symptoms.


Subject(s)
Acute Kidney Injury/etiology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Rhabdomyolysis/etiology , Acute Kidney Injury/pathology , Acute Kidney Injury/virology , Adolescent , Antibodies, Viral/blood , Betacoronavirus/immunology , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/pathology , Coronavirus Infections/virology , Humans , Immunoglobulin G/blood , Male , Nasopharynx/virology , Pandemics , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , Rhabdomyolysis/pathology , Rhabdomyolysis/virology , SARS-CoV-2
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