Abstract
BackgroundSARS-CoV2 virus could be potentially myopathic. Serum creatinine phosphokinase (CPK) is frequently found elevated in severe SARS-CoV2 infection, which indicates skeletal muscle damage precipitating limb weakness or even ventilatory failure.Case presentationWe addressed such a patient in his forties presented with features of severe SARS-CoV2 pneumonia and high serum CPK. He developed severe sepsis and acute respiratory distress syndrome (ARDS) and received intravenous high dose corticosteroid and tocilizumab to counter SARS-CoV2 associated cytokine surge. After 10 days of mechanical ventilation (MV), weaning was unsuccessful albeit apparently clear lung fields, having additionally severe and symmetric limb muscle weakness. Ancillary investigations in addition with serum CPK, including electromyogram, muscle biopsy, and muscle magnetic resonance imaging (MRI) suggested acute myopathy possibly due to skeletal myositis.ConclusionWe wish to stress that myopathogenic medication in SARS-CoV2 pneumonia should be used with caution. Additionally, serum CPK could be a potential marker to predict respiratory failure in SARS-CoV2 pneumonia as skeletal myopathy affecting chest muscles may contribute ventilatory failure on top of oxygenation failure due to SARS-CoV2 pneumonia.
Highlights
We wish to stress that myopathogenic medication in SARS-CoV2 pneumonia should be used with caution
Recent data from Wuhan, China, suggest that neurological symptoms/signs are present in over 30% of patients with severe SARS-CoV2 infection [1]. It spans from involvement of the central to the peripheral nervous system manifesting as headache, dizziness, encephalopathy, epileptic seizures, and stroke or muscle weakness
Islam et al Skeletal Muscle (2021) 11:10 myopathic weakness has been documented in six patients in severe SARS-CoV2 pneumonia requiring mechanical ventilation [3], the mechanism of skeletal muscle damage remained elusive
Summary
We wish to stress that myopathogenic medication in SARS-CoV2 pneumonia should be used with caution.
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