Rhabdomyolysis in severe COVID-19 infection with invasive ventilation treated by intermittent renal replacement therapy：a case report

Abstract

Novel coronavirus infection (COVID-19) causes not only severe pneumonia, but also renal dysfunction and neuromuscular manifestation. Although COVID-19 medication treatment recommendations are now more precise, rhabdomyolysis instances still uncommon and there is no approved treatment for them. A woman in her 60s had COVID-19 four days before admission. She had worsening dyspnea and weakness with CK 49,920 IU/L and Cr 4.01 mg/dL and was admitted with a diagnosis of COVID-19 with rhabdomyolysis and acute kidney injury (AKI). She continued oliguria, and was resuscitated with a crystalloid solution. She performed renal replacement therapy（RRT） on day 2 and was intubated due to worsening respiratory status on day 3. However, she was discontinued RRT on day 9, and underwent extubation on day 13. She was moved to a rehabilitation facility on day 104 because she needed extensive rehabilitation for the significant motor dysfunction. Here, we demonstrate a case that early combined RRT with ventilator management for COVID-19 with rhabdomyolysis resulting in AKI, that could prevent long-term oxygen therapy and maintenance dialysis.