Abstract
A 33-year-old, previously well, double-vaccinated female presented with two days of right leg pain following confirmed mild coronavirus disease (COVID19) four days prior. Initial examination revealed bilateral, right-predominant lower limb pyramidal weakness (Medical Research Council grade 3–4/5), absent right ankle jerk, bilateral flexor plantar reflexes and altered sensation in the right leg. She had urinary retention (700mls) and bruising over her right thigh. Incomplete transverse myelitis was first suspected, and she received 1g intravenous methylprednisolone for 3 days, but magnetic resonance imaging (MRI) spine and cerebrospinal fluid returned normal.
On day 5 of admission, she developed worsening right thigh pain and swelling (right thigh circumference was 12 centimetres more than left). Creatinine kinase was 75300 IU/L. Right lower limb doppler ultrasound excluded deep vein thrombosis. Electromyography showed no myogenic abnormalities. MRI right thigh showed widespread intramuscular myonecrosis with compression of the right sciatic nerve. She was managed with intravenous hydration, and daily monitoring of CK and renal function. The motor weakness and CK improved to normal over subsequent weeks.
Rhabdomyolysis has been previously reported in COVID19 infection in a small cohort of 10 unvaccinated patients with severe disease.1 Autoimmune myocyte cross-reactivity has been postulated. Autopsy of psoas muscle and femoral nerve samples from 35 COVID19 patients showed inflammatory and immune-mediated damage but no evidence of direct viral invasion on light microscopy. This report demonstrates that rhabdomyolysis may occur in vaccinated patients with mild COVID19. The role of steroids in this situation is uncertain, although, our patient had a favourable outcome.
References
Case Reports: Rhabdomyolysis Associated with COVID-19; Am Fam Physician 2020;102(11):645–648.
