Severe myopathy complicating multisystem inflammatory syndrome in adults (MIS-A) in a young man.

We report the case of a man in his early 30s who presented with high fever, cervical lymphadenopathy, maculopapular rash and considerably elevated inflammatory markers. Further evaluations revealed cardiomyopathy and renal failure. During hospitalisation he developed profound generalised muscle weakness caused by diffuse myopathy without elevated creatine kinase. He was eventually diagnosed with multisystem inflammatory syndrome in adults (MIS-A) after it was established that he had been suffering from COVID-19 5 weeks prior to presentation. He was started on intravenous immunoglobulins and high-dose corticosteroids, after which symptoms resolved rapidly. MIS-A is a rare but severe complication of COVID-19, whose pathogenesis is insufficiently understood. This case provides further insight into this new disease entity by describing a previously unreported disease progression with severe inflammatory myopathy without elevated creatine kinase.

Severe refeeding syndrome after human chorionic gonadotropin diet: a potentially lethal complication.

We present the case of a young male patient who presented with paralysing muscle weakness due to severe hypokalaemia and hypophosphataemia. The initial patient history evaluations could not establish the aetiology. Only after we reviewed the patient's history did he reveal that he had been following a severe calorie-restricted regime, the human chorionic gonadotropin diet, which had ended 2 days prior to developing symptoms. This information then allowed us to diagnose severe refeeding syndrome. As a further complication, the patient developed rhabdomyolysis. After correction of serum electrolytes, symptoms resolved completely. This case emphasises the potential harm of severely calorie-restricted diets, often recommended by online 'experts'. Furthermore, we underline the importance of thorough history taking.