COVID-19 PNEUMONIA ASSOCIATED WITH  RHABDOMYOLYSIS IN PATIENT WITH PREVIOUS CHRONIC THERAPY WITH STATIN: COINCIDENCE OR REALTED CONDITIONS?

Marija Janeku Kartalova; Marija Cvetanovska; Milena Stevanovic; Ilir Demiri; Sunchica Taseva Bogoeva; Vlatko Cvetanovski

Marija Janeku Kartalova University Clinic for Infectious Diseases and Febrile Conditions, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia,
Marija Cvetanovska University Clinic for Infectious Diseases and Febrile Conditions, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia,
Milena Stevanovic University Clinic for Infectious Diseases and Febrile Conditions, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia,
Ilir Demiri University Clinic for Infectious Diseases and Febrile Conditions, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia,
Sunchica Taseva Bogoeva University Clinic for Infectious Diseases and Febrile Conditions, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia,
Vlatko Cvetanovski General Hospital Remedika, Goce Delchev, University in Shtip, Republic of North Macedonia

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus which causes coronavirus disease 2019 (COVID-19). It was first identified amid an outbrake of respiratory illness cases in Wuhan City, Hubei Province, China. COVID-19 was reported to the world Health Organisation (WHO) on 31 December 2019 and declare as a global pandemic on 11 March 2020 . Presentation of COVID-19 range from asymptomatic or mild symptoms to severe illness or death. The most serious complication of COVID-19 is a type of pneumonia thatâ€™s been called 2019 novel coronavirus-infected pneumonia (NCIP). COVID-19 pneumonia presents as an atypical pneumonia, with diffuse bilateral lung involvement. Severe cases present with acute lung injury, and acute respiratory distress syndrome (ARDS). Rhabdomyolisis can be initial presentation of COVID-19, and also is a life-threatening disorder. Rhabdomyolysis is the breakdown of skeletal muscle by releasing it cellular content into the systemic circulation. A 73-year-old man was admitted to our hospital with bilateral pneumonia, muscle pain, and worsening symptoms. On hospital day 5 his oxygen saturation get low, so we started treatment with oxygen inhalation by high flow mask. On the 14th hospital day the muscle enzymes started increasing. After propriety treatment the patient was discharged on hospital day 28.Patient with COVID-19 pneumonia can developed rhabdomyolysis because of SARS CoV-2 infection also there is a risk of developing rhabdomyolysis after using drug for treatment of COVID-19. Our patient was on previous chronic therapy with statins but with normal liver and muscle enzymes. During his hospitalization and deteriorated of his clinical condition the enzymes increased with presentation of rhabdomyolysis. Our findings indicate that rapid clinical recognition and positive hydration treatment of COVID-19â€“asociated rhabdomyolysis can reduce the risk for serious complications.

Keywords: SARS-CoV-2, COVID-19, COVID-19 pneumonia, rhabdomyolysis, chronic statin therapy

https://doi.org/10.55302/JMS2141006jk

References

1.Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8:e26.
2.Cucinotta D, Vanelli M (2020) WHO declares COVID-19 a pandemic. Acta Biomed 91: 157-160.
3.Harapan H, Naoya I, Amanda Y, Wira W, Synat K, et al. (2020) Coronavirus disease 2019 (COVID-19): A literature review. J Infect Public Heal 13: 667-673.
4.Zhang et al., 2020 H. Zhang, et al. Angiotensin-converting enzyme (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med, 46 (4) (2020), pp. 586-590, 10.1007/s00134-020-05985-9
5.Chansrichavala et al., 2009 P. Chansrichavala, et al. Atorvastatin attenuates TLR4-mediated NF-kappaB activation in a MyD88-dependent pathway. Asian Pac J Allergy, 27 (2009), pp. 49-57
6.Zutt R, van der Kooi AJ, Linthorst GE, Wanders RJ, de Visser M. Rhabdomyolysis: review of the literature. Neuromuscul Disord. 2014;24:651â€“9. 10.1016/j.nmd.2014.05.005
7.Nance JR, Mammen AL. Diagnostic evaluation of rhabdomyolysis. Muscle Nerve. 2015;51:793â€“810. 10.1002/mus.24606
8.Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020. 10.1056/NEJMoa2002032.
9.Turner RM, Pirmohamed M. Statinâ€related myotoxicity: a comprehensive review of pharmacokinetic, pharmacogenomics and muscle components. J Clin Med 2020
10.Rhabdomyolysis associated with acute renal failure in patients with severe acute respiratory syndrome. Chen L-L, Hsu C-W, Tian Y-C, Fang J-T. Int J Clin Pract. 2005;59:1162â€“1166.
11.9. Acute renal failure in patients with severe acute respiratory syndrome. Huang J-W, Chen K-Y, Tsai H-B, et al. https://pubmed.ncbi.nlm.nih.gov/16607445/ J Formos Med Assoc. 2005;104:891â€“896.
12. Bacterial, fungal, parasitic, and viral myositis. Crum-Cianflone NF. Clin Microbiol Rev. 2008;21:473â€“494.
13. Rhabdomyolysis associated with 2009 influenza A(H1N1) Ayala E, Kagawa FT, Wehner JH, Tam J, Upadhyay D. JAMA. 2009;302:1863â€“1864
14.Rhabdomyolysis secondary to influenza a infection: a case report and review of the literature. Fadila MF, Wool KJ. North Am J Med Sci. 2015;7:122â€“124
15.Highlight of immune pathogenic response and hematopathologic effect in SARS-CoV, MERS-CoV, and SARS-Cov-2 infection. Liang Y, Wang M-L, Chien C-S, et al. Front Immunol. 2020;11:1022.
16.Rhabdomyolysis and acute kidney injury. Bosch X, Poch E, Grau JM. N Engl J Med. 2009;361:62â€“72
17.Rhabdomyolysis: review of the literature. Zutt R, van der Kooi AJ, Linthorst GE, Wanders RJA, de Visser M. Neuromuscul Disord. 2014;24:651â€“659.
18.Stanley M, Adigun R. Treasure Island, FL: StatPearls Publishing; [May;2020 ]. 2020. Rhabdomyolysis.
19.Li and Fan, 2020 J. Li, J.G. Fan Characteristics and mechanism of liver injury in 2019 coronavirus disease J Clin Transl Hepatol, 8 (1) (2020), pp. 13-17, 10.14218/JCTH.2020.00019.
20.Parekh R, Care DA, Tainter CR. Rhabdomyolysis: advances in diagnosis and treatment. Emerg Med Pract. 2012;14:1â€“15, quiz 15.