Development of Rhabdomyolysis in the Long-term Period of Previous New Coronavirus Infection COVID-19 (Clinical Case Report)

Relevance. Rhabdomyolysis is one of the complications of the new coronavirus infection COVID-19, which may cause acute kidney injury (AKI). The reason for the development of rhabdomyolysis in our observation in a patient after suffering COVID-19 in the long-term period was an increased muscle load.
Aim of study. Presentation of a case of rhabdomyolysis with AKI in a patient after COVID-19 in the long-term period.
Material and methods. In clinical observation, a 25-year-old patient L. is presented, who was being treated in the Department for the Treatment of Acute Endotoxicosis of the N.V. Sklifosovsky Research Institute for Emergency Medicine. In 2020, he developed COVID-19, complicated by rhabdomyolysis and AKI in the long term period.
Results. Examination revealed an increase in creatinine phosphokinase (CPK) — 106,000.0 U/L, alanine aminotransferase (ALT) — 553.0 U/L, aspartate aminotransferase (AST) — 1582.0 U/L, lactate dehydrogenase (LDH) — 2809.0 U/L, levels of serum creatinine 164 μmol/L and myoglobin — 201 ng/ml. Virological research: IgM — 0.27 units per ml; IgG — 7.28 units per ml. 3 Three-phase scintigraphy with 99mTc-pyrfotech revealed signs of necrotic changes in the muscles of the upper half of the back, muscles of the chest (mainly on the right), muscles of the shoulder and upper half of the forearm on both sides. Kidneys: decreased perfusion of the right kidney (relative to the left), moderate slowdown of urodynamics at the level of the calyx-pelvis complex on both sides.
Conclusions. The reason for the development of rhabdomyolysis in the long-term period in the patient after suffering from COVID-19 was an increased muscle load. Targeted research and medical history can help identify signs of rhabdomyolysis. The use of the radionuclide diagnostic method makes it possible to identify areas of soft tissue damage with a one-step assessment of renal function in rhabdomyolysis in the acute period of the disease, as well as to evaluate the effectiveness of treatment with dynamic observation. When rhabdomyolysis is confirmed, it is necessary to carry out detoxification and infusion therapy, to monitor renal function in order to detect acute kidney injury, and in case of deterioration of renal function and intoxication, renal replacement therapy is indicated.

1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. PMID: 31986264 https://doi.org/10.1016/S0140-6736(20)30183-5

2. Suwanwongse K, Shabarek N. Rhabdomyolysis as a Presentation of 2019 Novel Coronavirus Disease. Cureus. 2020;12(4):e7561. PMID: 32382463 https://doi.org/10.7759/cureus.7561

3. Chan KH, Farouji I, Hanoud AA, Slim J. Weakness and elevated creatinine kinase as the initial presentation of coronavirus disease 2019. Am J Emerg Med. 2020;38(7):1548.e1–1548.e3. PMID: 32414522 https://doi.org/10.1016/j.ajem.2020.05.015

4. Zhang Q, Shan KS, Minalyan A, O’Sullivan C, Nace T. A Rare Presentation of Coronavirus Disease 2019 (COVID-19) Induced Viral Myositis With Subsequent Rhabdomyolysis. Cureus. 2020;12(5):e8074. PMID: 32542129 https://doi.org/10.7759/cureus.8074

5. Gefen AM, Palumbo N, Nathan SK, Singer PS, Castellanos-Reyes LJ, Sethna CB. Pediatric COVID-19-associated rhabdomyolysis: a case report. Pediatr Nephrol. 2020;35(8):1517–1520. PMID: 32447505 https://doi.org/10.1007/s00467-020-04617-0

6. Jin M, Tong Q. Rhabdomyolysis as Potential Late Complication Associated with COVID-19. Emerg Infect Dis. 2020;26(7):1618–1620. PMID: 32197060 https://doi.org/10.3201/eid2607.200445

7. Zutt R, van der Kooi AJ, Linthorst GE, Wanders RJA, de Visser M. Rhabdomyolysis: review of the literature. Neuromuscul Disord. 2014;24(8):651–659. PMID: 24946698 https://doi.org/10.1016/j.nmd.2014.05.005

8. Coco TJ, Klasner AE. Drug-induced rhabdomyolysis. Curr Opin Pediatr. 2004;16(2):206–210. PMID: 15021204 https://doi.org/10.1097/00008480-200404000-00017

9. Huerta-Alardin AL, Varon J, Marik PE. Bench-to-bedside review: Rhabdomyolysis an overview for clinicians. Critl Care. 2005;9(2):158–169. PMID: 15774072 https://doi.org/10.1186/cc2978

10. Mikkelsen TS, Toft P. Prognostic value, kinetics and effect of CVVHDF on serum of the myoglobin and creatine kinase in critically ill patients with rhabdomyolysis. Acta Anaesthesiol Scand. 2005;49(6):859–864. PMID: 15954972 https://doi.org/10.1111/j.1399-6576.2005.00577

11. Talaie H, Pajouhmand A, Abdollahi M, Panahandeh R, Emami H, Hajinasrolah S, et al. Rhabdomyolysis among acute human poisoning cases. Hum Exp Toxicol. 2007;26(7):557–561 PMID: 17884958 https://doi.org/10.1177/0960327107078667

12. Perreault S, Birca A, Piper D, Nadeau A, Gauvin F, Vanasse M. Transient creatine phosphokinase elevations in children: a single-center experience. J Pediatr. 2011;159(4):682–685. PMID: 21592501 https://doi.org/10.1016/j.jpeds.2011.03.045

13. Rosa NG., Silva G, Teixeira A, Rodrigues F, Araújo JA. Rhabdomyolysis. Acta Med Port. 2005;18(4):271–281. PMID: 16584660

14. Singh D, Chander V, Chopra K. Rhabdomyolysis. Methods Find Exp Clin Pharmacol. 2005;27(1):39–48. PMID: 15834458 https://doi.org/10.1358/mf.2005.27.1.875435

15. Crum-Cianflone NF. Bacterial, fungal, parasitic, and viral myositis. Clin Microbiol Rev. 2008;21(3):473–494. PMID: 18625683 https://doi.org/10.1128/CMR.00001-08

16. Ayala E, Kagawa FT, Wehner JH, Tam J, Upadhyay D. Rhabdomyolysis associated with 2009 influenza A(H1N1). JAMA. 2009;302(17):1863–1864. PMID: 19887664 https://doi.org/10.1001/jama.2009.1582

17. Fadila MF, Wool KJ. Rhabdomyolysis secondary to influenza a infection: a case report and review of the literature. North Am J Med Sci. 2015;7(3):122–124. PMID: 25839005 https://doi.org/10.4103/1947-2714.153926

18. Wu VC, Hsueh PR, Lin WC, Huang JW, Tsai HB, Chen YM, et al. Acute renal failure in SARS patients: more than rhabdomyolysis. Nephrol Dial Transplant. 2004;19(12):3180–3182. PMID: 15575009 https://doi.org/10.1093/ndt/gfh436

19. Chen LL, Hsu CW, Tian YC, Fang JT. Rhabdomyolysis associated with acute renal failure in patients with severe acute respiratory syndrome. Int J Clin Pract. 2005;59(10):1162–1166. PMID: 16178983 https://doi.org/10.1111/j.1368-5031.2005.00540.

20. Singh U, Scheld WM. Infectious etiologies of rhabdomyolysis: three case reports and review. Clin Infect Dis. 1996;22(4):642–649. PMID: 8729203 https://doi.org/10.1093/clinids/22.4.642

21. Wen Z, Liang Y, Hao Y, Delavan B, Huang R, Mikailov M, et al. DrugInduced Rhabdomyolysis Atlas (DIRA) for idiosyncratic adverse drug reaction management. Drug Discovery Today. 2019;24(1):9–15. PMID: 29902520 https://doi.org/10.1016/j.drudis.2018.06.006

22. Liang Y, Wang M-L, Chien C-S, Yarmishyn AA, Yang Y-P, Lai W-Y, et al. Highlight of immune pathogenic response and hematopathologic effect in SARS-CoV, MERS-CoV, and SARS-Cov-2 infection. Front Immunol. 2020;11:1022. PMID: 32574260 https://doi.org/10.3389/fimmu.2020.01022 eCollection 2020.

23. Gurok EA, Sinyakova OG, Aleksandrova IV, Marchenkova LV, Kudryashova NE. Stsintigrafiya pochek i myagkikh tkaney v diagnostike sindroma pozitsionnogo sdavleniya. In: Radiologiya – 2007: materialy Vseros. kongr. s mezhd. uch. po luchevoy diagnostike i luchevoy terapii. Moscow; 2007. pp. 111–112. (in Russ.).

24. Marchenkova LV, Aleksandrova IV, Rey SI, Pervakova EI, Il’inskiy ME, Donova LV, et al. Prognosticheskie faktory razvitiya ostroy pochechnoy nedostatochnosti i neblagopriyatnogo iskhoda u bol’nykh s sindromom pozitsionnogo sdavleniya myagkikh tkaney. In: Bezopasnost’ bol’nogo v anesteziologii-reanimatologii: materialy 6-oy nauch.-prakt. konf. Moscow; 2008. pp. 47–48. (in Russ.).

25. Marchenkova LV, Berdnikov GA, Kudryashova NE, Ermolov AS. Drugassociated rhabdomyolysis. Modern approaches to diagnostics and treatment. Medical alphabet. 2018;1(9):8–13. (In Russ.).

26. Chan KH, Slim J. Rhabdomyolysis as Potential Late Complication Associated with COVID-19. Emerg Infect Dis. 2020;26(10):2535. PMID: 32614765 https://doi.org/10.3201/eid2610.202225

27. Chiba N, Matsuzaki M, Mawatari T, Mizuochi M, Sakurai A, Kinoshita K. Beneficial effects of dantrolene in the treatment of rhabdomyolysis as a potential late complication associated with COVID-19: a case report. Eur J Med Res. 2021;26(1):18. PMID: 33557936 https://doi.org/10.1186/s40001-021-00489-8