Severe Rhabdomyolysis Complicated With Acute Kidney Injury Required Renal Replacement Therapy After Pfizer COVID-19 Vaccine

Abstract

The adverse effects of coronavirus disease 2019 (COVID-19) vaccines are somewhat common but rarely life-threatening. Diagnosing life-threatening vaccine-related adverse effects is heavily dependent on history taking and ruling out the other possible causes. Vaccine-related complications vary, so awareness of possible complications can lead to efficient management. We present the case of a 58-year-old woman with a history of schizophrenia who received the COVID-19 Pfizer vaccine and developed severe rhabdomyolysis. She required renal replacement therapy and fully recovered with possible transient autoimmune activity. This case highlights the importance of early awareness of adverse effects following vaccine administration and careful history taking and monitoring to avoid life-threatening conditions.

Keywords: covid 19; covid-19 vaccine complication; pfizer-biontech covid-19 vaccine; rhabdomyolysis with acute renal failure; vaccine induced rhabdomyolysis.

Figure 1. Magnetic Resonance Image of her Thigh and Femur

Generally showed diffuse subcutaneous edema bilaterally, Some left femoral bone marrow edema in the neck and trochanteric region could represent transient osteoporosis versus bone contusion. No cortical bone destruction. (A) Coronal view of pelvic T1 weighted MRI with increased signal intensity of adductor longus muscle (arrow). (B) Axial view of pelvic T1 weighted MRI with increased signal intensity of gluteus medius tendon (arrow). All findings were suggestive of myositis. Abbreviation: MRI, magnetic resonance imaging.

Figure 2. Kidney Biopsy Results with Negative Control Comparison

(A&B) Renal proximal tubules with degenerative epithelial changes and irregular red-brown tubular casts with sharply defined edges (asterisk). The interstitium shows moderate mixed chronic inflammation and edema, x400 and x200, respectively (H&E stain). (C) Tubular casts demonstrate positive immunoreactivity for myoglobin (asterisk) by immunohistochemistry, x400, DAB, Ventana BenchMark Ultra (Roche Diagnostics, Basel, Switzerland). (D) Negative control immunohistochemistry slide demonstrating tubular casts with negative immunoreactivity, x400, DAB, Ventana BenchMark Ultra. Abbreviation: H&E, hematoxylin and eosin; DAB, diaminobenzidine.