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Volume 26, Number 10—October 2020
Letter

Rhabdomyolysis as Potential Late Complication Associated with COVID-19

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To the Editor: Jin and Tong described a patient with severe coronavirus disease (COVID-19) in whom rhabdomyolysis developed on day 9 of hospitalization (1). The interplay between severe acute respiratory syndrome coronavirus 2 and rhabdomyolysis is not yet understood; we consider possible etiologies for this case of rhabdomyolysis.

We reported 2 case-patients with COVID-19 who also had weakness and elevated creatinine kinase levels (but no respiratory symptoms) (2). As part of his COVID-19 treatment regimen, the patient reported by Jin and Tong received lopinavir and meropenem, which can cause rhabdomyolysis (3,4). Meropenem is associated with rhabdomyolysis by inducing severe hypomagnesemia and hypokalemia; it would be helpful to know the trends in the patient’s electrolytes before rhabdomyolysis developed (3). A cytokine storm might also have caused this complication because rhabdomyolysis developed on day 15 of COVID-19 symptoms and coincided with the peak of inflammatory markers (C-reactive protein). On the other hand, the combination of hypoxia and hypercoagulability might have induced an ischemic event that inhibited blood flow to the involved muscles, triggering rhabdomyolysis.

Clinicians treating rhabdomyolysis concurrent with COVID-19 must assess the many differential diagnoses, including severe acute respiratory syndrome coronavirus 2–induced myositis, reactions to medication, cytokine storm, hypoxia, or a thromboembolic event. This differential diagnosis is crucial because each condition has a distinct therapeutic approach.

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Kok Hoe ChanComments to Author  and Jihad Slim

Author affiliations: Saint Michael’s Medical Center, New York Medical College, Newark, New Jersey, USA

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References

  1. Jin  M, Tong  Q. Rhabdomyolysis as potential late complication associated with COVID-19. Emerg Infect Dis. 2020;26:161820. DOIPubMed
  2. Chan  KH, Farouji  I, Abu Hanoud  A, Slim  J. Weakness and elevated creatinine kinase as the initial presentation of coronavirus disease 2019 (COVID-19). Am J Emerg Med. 2020;38:1548.e13. DOIPubMed
  3. de Kanter  CT, Keuter  M, van der Lee  MJ, Koopmans  PP, Burger  DM. Rhabdomyolysis in an HIV-infected patient with impaired renal function concomitantly treated with rosuvastatin and lopinavir/ritonavir. Antivir Ther. 2011;16:4357. DOIPubMed
  4. Margolin  L. Impaired rehabilitation secondary to muscle weakness induced by meropenem. Clin Drug Investig. 2004;24:612. DOIPubMed

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Cite This Article

DOI: 10.3201/eid2610.202225

Original Publication Date: September 17, 2020

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Table of Contents – Volume 26, Number 10—October 2020

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Kok Hoe Chan, Saint Michael’s Medical Center, Newark, NJ 07101, USA

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Page created: June 30, 2020
Page updated: September 17, 2020
Page reviewed: September 17, 2020
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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