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Myositis due to COVID-19
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  1. Sadettin Uslu
  1. Rheumatology, Ömer Halisdemir University Bor Physical Medicine and Rehabilitation Training and Research Hospital, Nigde 51200, Turkey
  1. Correspondence to Dr Sadettin Uslu, Rheumatology, Niğde Ömer Halisdemir University, Nigde 51200, Turkey; sadouslu{at}gmail.com

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A 38-year-old man presented with dyspnoea and myalgia. Examination revealed tachycardia at 115 beats per minute and oxygen saturation (SpO2) of 88% on room air. He had lower extremity muscle weakness. Motor testing revealed a bilateral ankle plantarflexion deficit graded at 3/5 on the Medical Research Council muscle scale. All nerve reflexes were normal. The patient’s medical history was unremarkable.

On admission, blood work-up revealed creatine kinase (CK) of 19.250 IU/L (n<195 IU/L), C reactive protein (CRP) of 72 mg/L (n<5 mg/L), D-dimer of 1430 ng/ mL and lymphocytopenia. CT of the lung revealed bilateral ground-glass opacities (figure 1A). PCR testing for SARS-CoV-2 was positive. The results of influenza PCR were negative. A distal lower limb MRI showed bilateral gastrocnemius oedema, compatible with bilateral myositis (figure 1B). All immunological tests looking for any forms of myositis were negative. The diagnosis of COVID-19-associated myositis and pneumonitis was established, and a 5-day course of 1000 mg intravenous methylprednisolone, hydroxychloroquine and favipiravir was started. Over 5 days, his CK and CRP levels normalised. On day 10, a clear improvement in the patient’s general condition was observed, with an SpO2 of 97% without any need for supplemental oxygen.

Figure 1

(A) CT scan showing ground-glass opacities and (B) MRI in T2 short-tau inversion recovery sequence showing bilateral gastrocnemius muscle oedema (asterisk).

Viral infections such as influenza A and B are well-known causes of myositis.1 A study performed in patients with COVID-19 reported that about 13.7% of these patients had elevated CK levels. Muscle weakness related to COVID-19 has been reported in two patients with the MRI documentation of such myositis.2 3 We present an extremely rare case diagnosed with COVID-19-associated myositis.

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Footnotes

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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