Rhabdomyolysis as a late complication of COVID-19 infection

Introduction: The 2019 novel Coronavirus (COVID-19) is a betacoronavirus which typically presents with fever, cough, myalgia, and fatigue and can be associated with acute kidney injury (AKI) Recently, several cases of rhabdomyolysis (with and without AKI) have been reported with COVID-19 infection We present a case of a patient with COVID-19 infection who developed rhabdomyolysis on hospital day 22 Case Description: A 74-year-old man presented with several weeks of progressive malaise, dyspnea, fatigue, and nausea He was hypoxic to 87%, febrile (38 8 C) and had diffuse bilateral infiltrates on chest x-ray [Figure 1] He was intubated on hospital day 1 Testing for COVID-19 by PCR was positive Creatinine improved from 1 6 to 0 9 mg/dL with 2L of IV fluids He did not require vasopressors On hospital day 22, while still intubated, his creatinine increased from 1 4 to 3 8 mg/dL The level of creatinine phosphokinase (CPK) had was 7393 U/L from 118U/L on admission, and his plasma free myoglobin was 34,640 mcg/L Urinalysis was positive for 3+ occult blood, few red blood cells, and many granular casts His serum creatinine peaked at 6 67 mg/dL on hospital day 26 and subsequently declined to 1 6 by hospital day 33 Discussion: Rhabdomyolysis is an infrequent complication of COVID-19 infection When observed, rhabdomyolysis is typically present on admission This is, to our knowledge, the latest that rhabdoymyolysis has been observed in COVID infection The patient's inflammatory markers were not re-checked at the time of this event, though worsening inflammation may have provoked this event Their troponin was mildly elevated;a TTE was not performed No bed sores were observed, and the patient had no access to illicit substances No medications known to cause rhabdomyolysis were given prior to this development This case report suggests that rhabdomyolysis-related AKI may be a late complication of COVID-19 infection