A Case Report of Acute Respiratory Distress Syndrome and Rhabdomyolysis in Covid-19 Disease: An Interchange of Causes and Effects

Abstract

Coronavirus Disease 2019 (COVID-19) is an emerging disease from SARS-CoV2 that can cause acute respiratory distress syndrome (ARDS) that can present with extrapulmonary symptoms such as rhabdomyolysis. This is a case of a 55-year-old male known case of pulmonary tuberculosis (PTB) recently started on fixed dose combination therapy admitted due to non-rotatory dizziness and diaphoresis. He had hyponatremia (119mmol/L) and was given Tolvaptan 15mg OD. In the interim, he was noted to have myalgia, weakness, fever and watery diarrhea. COVID-19 RT-PCR swab was positive. CK-MM (52.11U/L) and CPK-total (2954U/L) levels were elevated. He was managed as a case of rhabdomyolysis and PTB medications were withheld. Chest x-ray showed bilateral infiltrates. Inflammatory markers showed elevations in LDH 734U/L, CRP 62mg/L, Ferritin 4374.08ng/mL and Procalcitonin 0.12ng/mL. ABG showed respiratory alkalosis with severe hypoxemia (pO2 43mmHg). Patient was started on ceftriaxone 2gm IV OD, remdesivir (200mg IV loading dose, then 100mg IV OD), dexamethasone 6mg IV OD, hemodialysis and hemoperfusion, convalescent plasma (2 aliquots), enoxaparin 0.6cc SC OD, and was hooked to high flow nasal cannula (FiO2 80%, Flow 30LPM, Temp 35°C). During the course of admission, HE HAD atrial fibrillation in rapid ventricular response, hypomagnesemia (0.75mmol/L), hypokalemia (2.9 mmol/L), and acute liver injury (AST 142U/L, ALT 116U/L), and was managed with colchicine 0.5mg/tab OD, trimetazidine 35mg/tab BID, digoxin 0.25mg IV (q4 hours for 6 doses then OD), ivabradine 7.5mg/tab BID, magnesium and potassium supplementation, and ademetionine 300mg/tab 2 tablets TID. Patient’s symptoms resolved and was weaned from oxygen support, and underwent pulmonary rehabilitation (incentive spirometry, musculoskeletal training/exercises) then discharged. In this article, we discussed the correlation of ARDS and rhabdomyolysis to COVID-19 and its implications on patient’s course of illness and recovery.