Pediatric COVID-19-associated rhabdomyolysis: a case report
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Pediatric COVID-19-associated rhabdomyolysis: a case report Ashley M. Gefen 1 & Nancy Palumbo 2 & Suresh K. Nathan 2 & Pamela S. Singer 1 & Laura J. Castellanos-Reyes 1 & Christine B. Sethna 1 Received: 12 May 2020 / Accepted: 13 May 2020 # IPNA 2020
Abstract COVID-19 is the illness caused by infection with the novel coronavirus SARS-CoV-2. Although myalgia is common in adults, it has not been noted as a common symptom in children. There have been a few reported cases of COVID-19-associated rhabdomyolysis in adults. This case report describes a 16-year-old boy who presented with fever, myalgias, mild shortness of breath with exertion, and dark-colored urine. COVID-19 PCR was positive. His initial creatinine kinase (CK) level was 427,656 U/L. Serum creatinine was normal for age. He was treated with isotonic intravenous fluids containing sodium bicarbonate to maintain urine output of 100–200 mL/h and urine pH > 7.0. His serum creatinine remained normal throughout the hospital stay and he was discharged on hospital day 12 with a CK of 6526 U/L. To our knowledge, no pediatric cases of COVID-19-associated rhabdomyolysis have been previously reported. Adult cases of rhabdomyolysis have been reported and a few reports have noted patients with elevated CK levels without rhabdomyolysis. Given this pediatric case of COVID-19-associated rhabdomyolysis, pediatric clinicians should be aware of this complication and manage fluids appropriately in order to prevent acute kidney injury. Keywords SARS-CoV-2 . Coronavirus . Creatine kinase . Children
Introduction COVID-19 is the illness caused by infection with the novel coronavirus SARS-CoV-2. SARS-CoV-2 first emerged in China in December 2019 and shortly thereafter spread worldwide. In adults, the most common presenting symptoms are fever (76– 91%), cough (63–65%), fatigue (38.5–50%), dyspnea (14–44%), anorexia (12–24%), diarrhea (15–28%), and myalgia (11–22%) [1–3]. In children, fever (36–41.5%), cough (19–48.5%), and diarrhea (9–12%) are most common [4–6]. Although myalgias are common in adults, no studies in children noted the presence of myalgias [4, 5]. There have been a few reported cases of COVID-19-associated rhabdomyolysis in adults, but no such cases have been reported in children [7–10]. Rhabdomyolysis is defined as the breakdown of skeletal muscle leading to leaking of muscle contents into the extracellular fluid [11]. Although there is no official consensus, it is * Christine B. Sethna [email protected] 1
Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children’s Medical Center of New York, New Hyde Park, NY, USA
2
Department of Pediatrics, Cohen Children’s Medical Center of New York, New Hyde Park, NY, USA
usually defined by a serum creatine kinase (CK) of > 1000 U/ L, which is five times the upper limit of normal [11]. Patients with rhabdomyolysis can be asymptomatic or present with myalgia, weakness, myoglobinuria with dark urine, significant electrolyte imbalance, and acute kidney injury [11]. Rhabdomyolysis in child
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