Rabdomyolysis as a serious complication of COVID-19

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.

Keywords

• rhabdomyolysis
• covid 19
• intensive care
• obesity
• creatine phosphokinasey