key: cord-0858429-tcordl8l
authors: Finsterer, Josef; Scorza, Fulvio A.
title: Does SARS-CoV-2 truly cause infectious myopathy?
date: 2020-09-01
journal: J Formos Med Assoc
DOI: 10.1016/j.jfma.2020.08.041
sha: 81ae49d6f400bd6f38a5f15ac18e003113da6787
doc_id: 858429
cord_uid: tcordl8l

nan

Josef Finsterer, MD, PhD [1] [1] . The patient required mechanical ventilation and was surprisingly tetraplegic after extubation [1] . The authors explained the condition as SARS-CoV-2 induced myopathy based upon the clinical presentation, blood chemical investigations, and electrophysiological findings [1] . We have the following comments and concerns. We do not agree that the index patent had myopathy due to infection with SARS-CoV-2. This appraisal is based on several considerations. First, there are no previous reports about SARS-CoV-2 induced myopathy. Second, no muscle biopsy was carried out showing inflammation inside the muscle, infiltration with lymphocytes, respectively the virus 3. The patient received a number of myotoxic drugs, which more probably explain muscle weakness. These drugs include rosuvastatin, azithromycine, lopinavir, ritonavir, chloroquine, From statins it is known that they may trigger statin myopathy in about 1% of the cases. From azithromycin and other macrolids it is well known that they may cause rhabdomyolysis [2] . Lopinavir/ritonavir are protease inhibitors, which are known to cause rhabdomyolysis and myopathy. Particularly in combination with statins and macrolids myotoxicity has been reported [3]. Chloroquine is known to cause autophagic, vacuolar myopathy [4] 4. The patient also could have had critical ill myopathy, since she was treated for several days on the intensive care unit. In this respect we should be informed if the patient also received steroids, from which it is known that they cause mitochondrial myopathy. An argument in favour of critical ill myopathy is that nerve conduction studies in the index patient revealed an asymmetric, axonal injury on the lower libs, suggesting that the previously healthy patient had also experienced critical ill neuropathy. We should know if myoglobin was elevated in the serum or in the urine. Overall, the interesting case report raises doubts about the diagnosis SARS-CoV-2 induced myopathy. More likely than infectious myopathy is toxic myopathy due to administration of statins, protease inhibitors, macrolides, and chloroquine. Most likely, the combination of these myotoxic drugs can be made responsible for quadriparesis during an infection with SARS-Cov-2. Hopefully, myotoxic drugs were discontinued after diagnosing myopathy and withdrawal of these drugs accelerated recovery from muscle weakness.

Myopathy associated with COVID-19