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Abstract: PO0801

Severe Rhabdomyolysis in the Time of Coronavirus

Session Information

Category: Trainee Case Report

  • 000 Coronavirus (COVID-19)

Authors

  • Alvarez Torres, Sergio E., Methodist Dallas Medical Center, Dallas, Texas, United States
  • Collazo-Maldonado, Roberto L., Methodist Dallas Medical Center, Dallas, Texas, United States
Introduction

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has become a global pandemic with alarming numbers of morbidity and mortality. COVID-19 primarily presents as a lung infection, with symptoms of fever, cough, myalgia, and fatigue. The severity of the disease may range from a mild upper respiratory infection to severe pneumonia, ARDS, and death. This novel disease can also present with involvement of multiple organ systems including the kidneys. Acute kidney injury (AKI) has been reported in up to 37 % of cases. Here we report a case of a woman with COVID-19 presenting with rhabdomyolysis and AKI.

Case Description

A 48 y/o Hispanic woman with history of HTN, hyperlipidemia and DM type 2 who presented to the ED complaining of shortness of breath, fever, cough, and myalgias. Four days before presentation she had been diagnosed with COVID-19 and was self-isolating at home. Her symptoms worsened prompting her visit to the ED. Vital signs showed fever of 103.1 F, pulse 86, respirations 37, blood pressure 106/58 and O2 Sat 85% at room air, 95% with nasal canula at 4 L. PE was normal except for tachypnea and coarse breath sounds bilaterally on lung auscultation. Admission labs were remarkable for AKI and rhabdomyolysis. Serum creatinine was 3.61, BUN 83, and total CK 106,193. U/A with blood, 5-10 RBC, 5-10 WBC and many bacteria. FeNA was 0.3%. Toxicology panel was negative. Respiratory viral panel was negative. Influenza A and B are negative. She initially received 2 L bolus of IV NS and then continued with balanced crystalloid solutions for volume expansion over the next 3 days. She received treatment with hydroxychloroquine, azithromycin and ceftriaxone for COVID-19 pneumonia. Her symptoms improved and serum creatinine and CK gradually decreased until back to normal levels.

Discussion

Rhabdomyolysis can be seen associated with viral infections. We presented a patient with COVID-19 and rhabdomyolysis. There are no studies establishing a mechanism for COVID-19 induced rhabdomyolysis. Patients with COVID-19 pneumonia are generally kept with negative fluid balance to avoid overload and worsening of ARDS. On the other hand, volume expansion is mainstay management for rhabdomyolysis. Clinicians should have a high suspicion for rhabdomyolysis in patients with COVID-19 presenting with myalgias and AKI. Early recognition of and appropriate treatment is crucial to improve outcomes.