SARS-CoV-2 associated rhabdomyolysis in 32 patients

Authors: JOSEF FINSTERER, FULVIO SCORZA

Abstract: Background/aim: This mini-review aims at summarising and discussing previous and recent findings concerning the clinical manifestations, therapeutic management, and outcome of SARS-CoV-2 associated rhabdomyolysis. Materials and methods: Literature search in the PubMed database by applying appropriate search terms. Results: A total of 26 articles reporting SARS-CoV-2 associated rhabdomyolysis in 32 patients were identified. Age ranged from 16 to 80 years. Four patients were female and 25 were male. Onset of rhabdomyolysis was prior to onset of COVID-19 in 7 patients, and after onset of COVID-19 in the remaining patients. Exposure to myotoxic medication was identified in 18 patients. Myotoxic drugs these patients were taking at the time rhabdomyolysis included azithromycin, hydroxy-chloroquine, placitaxel, propofol, imastinib, piperacillin and meropenem, hydrochlorothiazide, and acetaminophen. Peak creatine-kinase values ranged from 328 to >427656 U/l. The outcome was unreported in 8 cases, favourable in 15 partial, incomplete in 3 cases, and lethal in 6 cases. Conclusion: SARS-CoV-2 associated rhabdomyolysis is rare, may be most frequently due to the side effects of myotoxic anti-COVID-19 drugs, and only rarely due to virus myositis, and may have a favourable outcome in most patients.

Keywords: Rhabdomyolysis, coronavirus, ground glass opacities, skeletal muscle, myocyte necrosis

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