Weakness and elevated creatinine kinase as the initial presentation of coronavirus disease 2019 (COVID-19)

Abstract

COVID-19 is a global public health emergency with more than one million positive cases across the globe. COVID-19 has a multifaceted presentation. We are herein to report two cases of SARS-CoV-2 induced rhabdomyolysis with an initial presentation of weakness and elevated creatinine kinase (CK). Both patients had no respiratory symptoms, they only complained of generalized weakness and were found to have elevated CK. Routine chest X-ray showed bilateral infiltrates in both cases and subsequently reverse-transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 was positive. To the best of our knowledge, there was only one literature to date documented SARS-CoV-2 induced rhabdomyolysis as a late complication of COVID-19 patient. Our cases showed that elevated CK and rhabdomyolysis can be the sole initial presentation of patients with COVID-19 and total CK should be ordered in every patient on admission.

Keywords: COVID-19; Elevated creatinine kinase; Rhabdomyolysis; SARS-CoV-2.

Fig. 1

Chest X-ray portable view showing left lower lobe infiltrates.

Fig. 2

Chest CT showing bilateral ground glass opacities (axial section).

Fig. 3

Chest X-ray showing bilateral multifocal patchy opacities more on the peripheral and basal regions.