Rhabdomyolysis as a manifestation of a severe case of COVID-19: A case report

Abstract

Since the outbreak of the ongoing pandemic of the novel coronavirus disease (COVID-19) in Wuhan, China, from December 2019, we have learned that multiple organs can be affected with the potential for various complications. Although myalgia is a frequent symptom in COVID-19 patients, no imaging findings of rhabdomyolysis have been featured in the literature. We report a case of presumed rhabdomyolysis in a 38-year-old male with COVID-19 based on the clinical presentation, laboratory results and radiological findings. By discussing the diagnostic rationale and reviewing the relevant literature we hope to advance the existing understanding of this disease and its effects on the musculoskeletal system.

Keywords: COVID-19; Myositis; Rhabdomyolysis.

Fig. 1

Patient's first chest CT scan; on the day of admission. Axial CT scan in chest window showing bilateral scattered ground glass opacities (red arrows). (Color version available online.)

Fig. 2

Patient's second chest CT scan; 46th day post admission. (A) Coronal CT image in chest window showing left upper lobe cavitations (red asterisk). (B) Axial CT chest window showing a partially loculated moderate to large right hydropneumothorax (empyema), with air-fluid level and a probable bronchopleural fistula (green arrow) along with adjacent lower lobe consolidation (pneumonia). (Color version available online.)

Fig. 3

Patient's second chest CT scan; 46th day post admission. Axial images of the chest in soft tissue window, showing bilateral symmetrical, increased density with a concomitant decreased muscle bulk, involving the deltoid (1), trapezius (2), subscapularis (3), lattisimus dorsi (4), and the serratus anterior (5) rhomboid major (6) muscles.

Fig. 4

Patient's second chest CT scan; 46th day post admission. (A) Coronal image of Plain chest (lung window) showing bilateral symmetrical, increased density with a concomitant decreased muscle bulk, involving the deltoid (1), subscapularis (3), supraspinatus (6), teres major (7), triceps (8) muscles. (B) Sagittal image of Plain chest (soft tissue window) depicting the calcification within the muscles (red asterisks). (Color version available online.)

Fig. 5

Patient's third chest CT scan; 50th day post admission. Plain CT Chest showing interval increase within the bilateral posterior thoracic and shoulder muscular density.

Fig. 6

Patient's fourth chest CT scan; 57th day post admission. Plain CT Chest showing progressive interval increase within the bilateral posterior thoracic and shoulder muscular density.