Critical illness myopathy and polyneuropathy in a patient with severe COVID -19 infection – a case report

Cilj: Cilj ovoga rada je prikazati bolesnika s teškim oblikom infekcije COVID-19 koji je razvio miopatiju i polineuropatiju kritične bolesti, uz tešku funkcijsku onesposobljenost te proces rehabilitacije, uz pregled literature. Prikaz slučaja: Bolesnik u dobi od 58 godina razvija teški oblik infekcije COVID-19 uz razvoj akutne respiratorne insuficijencije zbog obostrane COVID pneumonije. Zbog pogoršanja kliničke slike mehanički je ventiliran, razvija septički šok te se liječi polifarmakološkom terapijom uz suportivno liječenje i doziranu rehabilitaciju. Nakon poboljšanja kliničkog statusa, bolesnik postaje vitalno i hemodinamski stabilan, na suplementaciji kisikom od 4L/min. Zbog razvoja miopatije i polineuropatije kritične bolesti (engl. Critical-Illness Related Myopathy and Neuropathy; CRYMNE) s posljedičnom generaliziranom teškom mišićnom slabosti uz tešku onesposobljenost, započinje post-COVID multidisciplinarnu rehabilitaciju po individualnom rehabilitacijskom programu (IRP). IRP se sastoji od respiratorne i neuromišićne rehabilitacije te rehabilitacije funkcije za osposobljavanje u aktivnostima svakodnevnog života. Nakon provedenog IRP-a bolesnik je bez zaduhe i zamora pri opterećenju. Saturacija kisikom je postojana te nema razloga za daljnjom oksigenoterapijom. Napredak u rehabilitacijskim ishodima prati se funkcijskim alatima te se registrira smanjenje bolova u zglobovima, jačanje mišićne snage velikih skupina mišića, povećanje snage stiska obiju šaka te smanjenje općeg umora. Bolesnik hoda samostalno pomoću hodalice i peronealne ortoze radi zaostale pareze obaju peroneusa, a mjere funkcijske neovisnosti također su poboljšane, što pridonosi boljoj kvaliteti života. Zaključak: Miopatija i polineuropatija kritične bolesti posljedice su složenih patofizioloških mehanizama uslijed dugotrajne vitalno ugrožavajuće bolesti uz razvoj teške onesposobljenosti i gubitka funkcije. Individualni rehabilitacijski program provodi se kontinuirano, prilagođen je težini kliničke slike, a provodi ga multidisciplinarni tim.Aim: The aim of this paper is to present a patient with severe COVID-19 infection who has developed critical illness myopathy and polyneuropathy (CRYMNE), with severe functional disability as well as the rehabilitation process, with a review of literature. Case report: A 58-year-old patient develops a severe form of COVID-19 infection with the development of acute respiratory failure due to bilateral COVID-19 pneumonia. Due to the worsening of the clinical condition, he is mechanically ventilated, develops septic shock and is treated with polypharmacological therapy with supportive treatment and gradually progressive rehabilitation. Upon improvement of clinical status, the patient becomes vital and hemodynamically stable, on oxygen supplementation of 4L/min. Due to the development of critical-illness related myopathy and neuropathy (CRYMNE) and the consequent generalized severe muscle weakness with severe disability, he started post- COVID-19 multidisciplinary rehabilitation according to an individual rehabilitation program (IRP). IRP consists of respiratory and neuromuscular rehabilitation, and rehabilitation of the training function in everyday life activities. According to the performed IRP, the patient is free of shortness of breath and fatigue. Oxygen saturation is persistent and there is no reason for further oxygen therapy. Progress in rehabilitation outcomes is monitored by functional tools and a reduction in joint pain, strengthening of muscle strength of large muscle groups, increase in the grip strength of both hands and reduction of general fatigue are registered. The patient walks independently with a walker and peroneal orthoses due to residual paresis of both peroneal nerves. Functional independence indexes as assessment tools of function have also been improved, which is proof of a better quality of life. Conclusion: CRYMNE is the consequence of complex pathophysiological mechanisms due to long-term, life-threatening disease with the development of severe disability and loss of function. The individual rehabilitation program is implemented continuously, adjusted to the severity of the clinical condition under supervision of a multidisciplinary team