PDF(Pubmed)
Abstract：
SARS-COVID-19 is known to manifest with a wide variety of symptoms, most of which are respiratory. Myalgias are a common symptom of COVID-19, but cases of severe virus-induced inflammatory muscle injury leading to rhabdomyolysis and polymyositis have also been reported. Here, we present and discuss a case of a 56-year-old woman who presented with an initial presentation of COVID-19 infection with inflammatory polymyositis leading to rhabdomyolysis. The patient was first treated for rhabdomyolysis with aggressive fluid resuscitation with intravenous normal saline without improvement in symptoms. She was then started on high-dose intravenous methylprednisolone for presumed immune-mediated polymyositis. An MRI of the bilateral lower extremities and a biopsy of the left thigh confirmed inflammatory myositis. After the initiation of steroids, liver function tests and creatinine kinase levels trended down, and symptoms improved. The patient was discharged with a prednisone taper and completely recovered at a follow-up six months later. Post-COVID severe musculoskeletal involvement, including polymyositis or rhabdomyolysis, is rare, with only a few other cases published so far. Viral myositis, supported by myopathological evidence, should be considered carefully in patients with a recent COVID-19 infection after ruling out more common causes of myositis. Some proposed mechanisms include direct infection of the muscle or an environmental event triggering autoimmunity. Treatment generally involves corticosteroids that are gradually tapered.
摘要：
已知SARS-COVID-19表现出各种各样的症状，其中大部分是呼吸。肌痛是COVID-19的常见症状，但也报道了严重的病毒诱导的炎性肌肉损伤导致横纹肌溶解和多发性肌炎的病例。这里,我们介绍并讨论一例56岁女性患者,该患者初次出现COVID-19感染并伴有炎性多发性肌炎,导致横纹肌溶解.该患者首先接受横纹肌溶解症治疗，并使用静脉生理盐水进行积极的液体复苏，而症状没有改善。然后，她开始使用大剂量静脉注射甲基强的松龙治疗假定的免疫介导的多发性肌炎。双侧下肢的MRI和左大腿的活检证实了炎性肌炎。类固醇开始后，肝功能检查和肌酐激酶水平呈下降趋势，症状改善。患者使用泼尼松锥度出院，并在六个月后的随访中完全康复。COVID后严重的肌肉骨骼受累，包括多发性肌炎或横纹肌溶解症，是罕见的，到目前为止，只有少数其他案例发表。病毒性肌炎,有肌肉病理学证据支持,在排除更常见的肌炎原因后，应仔细考虑近期感染COVID-19的患者。一些提出的机制包括肌肉的直接感染或引发自身免疫的环境事件。治疗通常涉及逐渐变细的皮质类固醇。
