Rabdomyolysis as a serious complication of COVID-19

Uri Adrian Prync Flato; Karina Vilariço Ferreira; Piero Biteli; Daniela Ortega Balbo Rodrigues Reina; Fábio Tadeu Rodrigues Reina; Fausto Tucunduva Vernaschi; Gabriela Achete de Souza; Gyovanna Sorrentino dos Santos Campanari; Júlia Novaes Matias; Vinícius Marinho Lima; Tereza Lais Menegucci Zutin; Rogério Leone Buchaim; Daniela Vieira Buchaim; Sandra Maria Barbalho; Uri Adrian Prync Flato; Karina Vilariço Ferreira; Piero Biteli; Daniela Ortega Balbo Rodrigues Reina; Fábio Tadeu Rodrigues Reina; Fausto Tucunduva Vernaschi; Gabriela Achete de Souza; Gyovanna Sorrentino dos Santos Campanari; Júlia Novaes Matias; Vinícius Marinho Lima; Tereza Lais Menegucci Zutin; Rogério Leone Buchaim; Daniela Vieira Buchaim; Sandra Maria Barbalho

doi:10.3934/bioeng.2021015

AIMS Bioengineering

2021, Volume 8, Issue 2: 165-172. doi: 10.3934/bioeng.2021015

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Case report Special Issues

Rabdomyolysis as a serious complication of COVID-19

Uri Adrian Prync Flato ^1,2,
Karina Vilariço Ferreira ²,
Piero Biteli ^1,2,
Daniela Ortega Balbo Rodrigues Reina ¹,
Fábio Tadeu Rodrigues Reina ¹,
Fausto Tucunduva Vernaschi ¹,
Gabriela Achete de Souza ²,
Gyovanna Sorrentino dos Santos Campanari ²,
Júlia Novaes Matias ²,
Vinícius Marinho Lima ²,
Tereza Lais Menegucci Zutin ²,
Rogério Leone Buchaim ³,
Daniela Vieira Buchaim ^1,2,4,
Sandra Maria Barbalho ^{1,2,5
,
,}

1.
Posgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Avenida Higino Muzzy Filho, 1001, Marília 17525-902, São Paulo, Brazil
2.
School of Medicine and Nursing, University of Marília (UNIMAR), Avenida Higino Muzzi Filho, 1001, Marília 17525-902, São Paulo, Brazil
3.
Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo (FOB – USP), Alameda Doutor Octávio Pinheiro Brisolla, 9-75, Bauru 17012-901, São Paulo, Brazil
4.
Medical School, University Center of Adamantina (UniFAI), Adamantina 17800-000, São Paulo, Brazil
5.
Department of Biochemistry and Nutrition, School of Food Technology of Marília, Marília 17506-000, São Paulo, Brazil

Received: 25 February 2021 Accepted: 09 April 2021 Published: 15 April 2021

Rhabdomyolysis is an acute condition with skeletal muscle damage and release of toxins produced by myocytes with variable clinical presentation. Laboratory diagnosis is based on an increase in serum creatine phosphokinase (CPK), which can trigger irreversible renal impairment. The aim was to describe the association of COVID-19 with rhabdomyolysis as a serious complication, in order to promote early diagnosis and treatment. Case description: Female patient, 18 years old, grade 3 obesity, complaining of dry cough for 7 days, associated with continuous fever for 4 days, myalgia of the lower limbs and moderate dyspnea for 2 days, was admitted to the emergency room and sent to the Intensive Care Unit (ICU), with positive PCR-RT. After 12 hours of admission, the patient developed severe hypoxemic acute respiratory failure. On the second day of hospitalization, an exponential increase in CPK was found and measures of volume optimization were initiated. On the seventh day of hospitalization, associated with increased CPK, a decline in renal function was observed, evolving to the need for renal replacement therapy. On the ninth day of hospitalization, she presented with multiple organ dysfunction and death. In conclusion, COVID-19 can generate rhabdomyolysis by direct myocyte injury by SARS-CoV-2, an exacerbated immune response to the virus resulting in a cytokine storm with concomitant muscle damage and through direct injury by circulating viral toxins. However, as it is an uncommon manifestation and presents a nonspecific clinical condition, early diagnosis is not always performed. This conclusion was based on the case report presented and not only on the results of the literature review, since the clinical case is in accordance with the literature and can contribute to the recognition of these conditions, leading to better management in the treatment.
- rhabdomyolysis,
- COVID 19,
- intensive care,
- obesity,
- creatine phosphokinasey
Citation: Uri Adrian Prync Flato, Karina Vilariço Ferreira, Piero Biteli, Daniela Ortega Balbo Rodrigues Reina, Fábio Tadeu Rodrigues Reina, Fausto Tucunduva Vernaschi, Gabriela Achete de Souza, Gyovanna Sorrentino dos Santos Campanari, Júlia Novaes Matias, Vinícius Marinho Lima, Tereza Lais Menegucci Zutin, Rogério Leone Buchaim, Daniela Vieira Buchaim, Sandra Maria Barbalho. Rabdomyolysis as a serious complication of COVID-19[J]. AIMS Bioengineering, 2021, 8(2): 165-172. doi: 10.3934/bioeng.2021015

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Abstract

Rhabdomyolysis is an acute condition with skeletal muscle damage and release of toxins produced by myocytes with variable clinical presentation. Laboratory diagnosis is based on an increase in serum creatine phosphokinase (CPK), which can trigger irreversible renal impairment. The aim was to describe the association of COVID-19 with rhabdomyolysis as a serious complication, in order to promote early diagnosis and treatment. Case description: Female patient, 18 years old, grade 3 obesity, complaining of dry cough for 7 days, associated with continuous fever for 4 days, myalgia of the lower limbs and moderate dyspnea for 2 days, was admitted to the emergency room and sent to the Intensive Care Unit (ICU), with positive PCR-RT. After 12 hours of admission, the patient developed severe hypoxemic acute respiratory failure. On the second day of hospitalization, an exponential increase in CPK was found and measures of volume optimization were initiated. On the seventh day of hospitalization, associated with increased CPK, a decline in renal function was observed, evolving to the need for renal replacement therapy. On the ninth day of hospitalization, she presented with multiple organ dysfunction and death. In conclusion, COVID-19 can generate rhabdomyolysis by direct myocyte injury by SARS-CoV-2, an exacerbated immune response to the virus resulting in a cytokine storm with concomitant muscle damage and through direct injury by circulating viral toxins. However, as it is an uncommon manifestation and presents a nonspecific clinical condition, early diagnosis is not always performed. This conclusion was based on the case report presented and not only on the results of the literature review, since the clinical case is in accordance with the literature and can contribute to the recognition of these conditions, leading to better management in the treatment.

Conflict of interest

The authors have declared no conflict of interest.

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