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Kidney Week

Abstract: PO0287

Acute Myositis Complicated by Rhabdomyolysis in Setting of COVID-19 Infection in a Patient on Rosuvastatin: A Case Report

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Kumar, Anand, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
  • Muraleedharan, Anjali, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
  • Lal, Yasir, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
Introduction

Viral illnesses are uncommon cause of rhabdomyolysis and AKI. A few cases of rhabdomyolysis have been reported with Covid-19 infection previously. However, Covid-19 presenting solely with rhabdomyolysis in absence of respiratory symptoms is rare. There is also paucity of data supporting steroids use in such cases. We present a case of COVID-19 related rhabdomyolysis who recovered in response to steroid therapy.

Case Description

This is a 78-year-old female with history of dyslipidemia and chronic kidney disease III who presented with generalized weakness and myalgias. Home medications included Rosuvastatin. She was diagnosed with Covid-19 virus. Rosuvastatin was held, however her myalgia muscle weakness worsened, and she was no longer able to stand without support. She denied fever, chills, rash , or respiratory symptoms.
At presentation, physical exam revealed diffuse muscle tenderness and diminished strength: 1/5 and 2/5 in proximal bilateral lower and upper extremities respectively. WBCs 11.13, K 5.7, Cr 5.72 , ANA, HMG CoA reductase antibody assay and myositis panel (SSA-52, SSA-60, Smith/RNP antibodies, anti-SMRNP, anti-SSA, anti-SSB, & RF) were negative. CK 14, 085 U/L , granular and muddy brown casts on urine microscopy. Lower extremities MRI showed bilateral muscular edema , EMG was consistent with myopathic changes. Muscle biopsy revealed scattered necrotic and regenerating fibers, diffuse type 2 fiber atrophy, and mild neurogenic changes, consistent with rhabdomyolysis. Immunohistochemistry showed rare perivascular B lymphocytes and plasma cells. CK continued to rise and peaked at 89,303 U/L. At that point steroid therapy was initiated. This resulted in a significant improvement in CK and creatinine over the next few days.

Discussion

Viral myositis leading to rhabdomyolysis and AKI as the primary presentation of Covid-19 infection is uncommon. In our case, a short course of steroids, resulted in quick recovery. Early recognition and diagnosis followed by intervention can prevent further muscle and renal damage and can shorten hospital stay and related morbidity significantly.

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