Finsterer, Dr. Josef

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International Journal of Medical Studies

                  International Journal of                                                                                                                                                                                                                                                                                   www.ijmsonline.in                              SARS-CoV-2 associated muscle damage can be diverseJosef Finsterer, MD, PhD*  *Klinik Landstrasse, Messerli Institute, AustriaCorresponding author: Dr. Finsterer J, Postfach 20, 1180 Article history Received 11 Feb 2021 Received in revised form 21 Feb 2021Accepted 24 Feb 2021 Available online 28 Feb 2021  Keywords: Myopathy, Creatine-KThis article reviewed by Dr. Prateekonline 28 Feb 2021. IJMS, all rights reserved.  Letter to the Editor The first shortcoming of the interesting article by Manzano et al. refers to the missing ultrastructural investigation of the muscle biopsy [1]. In a recent study electron microscopy of a COVID-19 patient’s biopsy revealed degenerated cells with cytoplasmidegenerated mitochondria, and cytoplasmic clusters of SARSnerve-conduction studies and needlerecognised to complicate COVIDlesions do not rule out dermatomyositis, increasingly recognised as a feature of COVID[4]. Since some of the drugs given to treat COVIDMedical StudiesAvailable online at www.ijmsonline.in                 IJMS 6(2), 32                 Print ISSN   2542 Letter to the Editor                                International Journal of Medical . Vienna, Austria  inase, Myoglobin, Skeletal Muscle, Weakness , Dr. Ram. Edited by Dr. Pradeep J., Dr. S Gaurc condensation, -CoV-2 particles [2]. Missing are -electromyography to rule out neuropathy, increasingly -19 [3], with secondary myopathic lesions. Absence of skin -19 are myotoxic (steroids, chloroquine,  -34 (2021)                                                              -2766   Studies      32 . Available -19                                Dr. Josef Finsterer et al.  www.ijmsonline.in                                                                International Journal of Medical Studies    33  azithromycin), muscle damage due to side effects of these drugs need to be excluded. Missing is the family history and the clinical neurologic exam to rule out a sub-clinically hereditary neuromuscular disorder, which became symptomatic through the infection. We should know the myoglobin levels and which drugs were given prior to admission for muscle weakness, myalgia, and fever to rule out rhabdomyolysis. The systemic inflammatory response, substantiated by elevated cytokine levels [5], should be excluded as the cause of the described cytopathy.  FUNDING SOURCE No funding was received.  USEFUL INFO Author contribution: JF: design, literature search, discussion, first draft, critical comments. Informed consent: was obtained. The study was approved by the institutional review board.  REFERENCES  1. Manzano GS, Woods JK, Amato AA. Covid-19-Associated Myopathy Caused by Type I Interferonopathy. N Engl J Med. 2020 Dec 10; 383(24): 2389-2390. doi: 10.1056/NEJMc2031085.  2. Hooper JE, Uner M, Priemer DS, Rosenberg A, Chen L. Muscle Biopsy Findings in a Case of SARS-CoV-2-Associated Muscle Injury. J Neuropathol Exp Neurol. 2020 Dec 22:nlaa155. doi: 10.1093/jnen/nlaa155.  3. Bureau BL, Obeidat A, Dhariwal MS, Jha P. Peripheral Neuropathy as a Complication of SARS-Cov-2. Cureus. 2020 Nov 12; 12(11):e11452. doi: 10.7759/cureus.11452.  4. Gokhale Y, Patankar A, Holla U, Shilke M, Kalekar L, Karnik ND, Bidichandani K, Baveja S, Joshi A. Dermatomyositis during COVID-19 Pandemic (A Case Series): Is there a Cause Effect Relationship? J Assoc Physicians India. 2020 Nov; 68(11): 20-24. PMID: 33187031.                                Dr. Josef Finsterer et al.  www.ijmsonline.in                                                                International Journal of Medical Studies    34  5. Mageriu V, Zurac S, Bastian A, Staniceanu F, Manole E. Histological findings in skeletal muscle of SARS-CoV2 infected patient. J Immunoassay Immunochem. 2020 Dec 22:1-10. doi: 10.1080/15321819.2020.1863819.    

SARS-CoV-2 associated muscle damage can be diverse

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SARS-CoV-2 associated muscle damage can be diverse

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International Journal of Medical Studies