COVID-19 and Rhabdomyolysis
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Internal Medicine Residency Program, Brigham and Women’s Hospital and Harvard Medical SchoolBoston, MA, USA; 2Department of Medicine, Brigham and Women’s Hospital and Harvard Medical SchoolBoston, MA, USA; 3Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical SchoolBoston, MA, USA; 4Renal Division, Brigham and Women’s Hospital and Harvard Medical SchoolBoston, MA, USA; 5Hospital Medicine Unit and the Division of General Internal Medicine, Brigham and Women’s Hospital and Harvard Medical School Boston, MA, USA.
J Gen Intern Med DOI: 10.1007/s11606-020-06039-y © Society of General Internal Medicine 2020
BACKGROUND
The ongoing pandemic of COVID-19 has become a focus of global research as many characteristics of this virus are still being defined.1 The most common symptoms currently associated with COVID-19 include fever, cough, and fatigue.2 Rhabdomyolysis is rarely seen and was only reported in 0.2% of patients in a study of 1099 patients in China.2 Common etiologies of rhabdomyolysis include trauma, strenuous exercise, prolonged immobilization, seizure, and toxins, including illicit substances such as cocaine, alcohol, and drugs including statins.3–5 Other viral infections including influenza A and other coronaviruses such as SARS have been associated with rhabdomyolysis.6,7 One case report from China describes SARS-CoV-2-associated rhabdomyolysis; however, in that case report, kidney function remained normal and rhabdomyolysis was not the presenting concern.8 Here, we present a case of severe rhabdomyolysis leading to acute kidney injury (AKI) as the primary presenting feature of COVID-19.
CASE REPORT
A 51-year-old man with a history notable for hypertension, recent diagnosis of non-insulin-dependent diabetes mellitus type 2 (HgbA1c of 7.6%), obstructive sleep apnea, and chronic kidney disease stage 2 presented to the emergency department with a chief concern of 2 days of diffuse myalgias including his chest, back, arms, and legs. The patient exercised regularly at the gym 5 days a week and primarily performed resistance exercises. Due to his general malaise, he had not Authorship All authors had full access to all of the medical data pertaining to the reported paper and take responsibility for the integrity and the accuracy of the data report and literature review. Received April 9, 2020 Accepted July 3, 2020
gone to the gym for 1 week prior to presentation. He described his presenting myalgias as similar in quality to muscle soreness from exercise but much more severe. Ultimately, he presented to care because his pain had become intolerable. He also described a slight dry cough and mild chills but no fevers. He denied any shortness of breath or sore throat. He had no recent trauma or immobilization. He denied any new medications or diet, weight loss, or exercise supplements. He did not have any recent alcohol intake or use of illicit substances including cocaine or amphetamines. He had no recent travel or sick contacts. He did not have any family history of rhabdomyolysis, other
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