Critical illness myopathy after COVID-19

• Published in: International journal of infectious diseases Vol. 99; pp. 276 - 278
• Main Authors: Bagnato, Sergio, Boccagni, Cristina, Marino, Giorgio, Prestandrea, Caterina, D’Agostino, Tiziana, Rubino, Francesca
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01-10-2020; The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases; Elsevier
• Subjects: Betacoronavirus; Case Report; Coronavirus Infections - complications; COVID-19; Critical Illness; Direct muscle stimulation; Electromyography; Female; Humans; ICU-acquired weakness; Middle Aged; Muscular Diseases - etiology; Pandemics; Pneumonia, Viral - complications; Rehabilitation; SARS-CoV-2; ICU-acquired weakness; SARS-CoV-2; Electromyography; Rehabilitation; Direct muscle stimulation
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2020.07.072

•Muscle weakness after COVID-19 can be caused by critical illness myopathy.•Critical illness myopathy should be suspected in patients with long ICU stay.•Health systems must plan access to rehabilitative facilities after COVID-19.
This paper describes a patient who developed diffuse and symmetrical muscle weakness after a long stay in the intensive care unit (ICU) due to coronavirus disease 2019 (COVID-19). The patient underwent a neurophysiological protocol, including nerve conduction studies, concentric needle electromyography (EMG) of the proximal and distal muscles, and direct muscle stimulation (DMS). Nerve conduction studies showed normal sensory conduction and low-amplitude compound muscle action potentials (CMAPs). EMG revealed signs of myopathy, which were more pronounced in the lower limbs. The post-DMS CMAP was absent in the quadriceps and of reduced amplitude in the tibialis anterior muscle. Based on these clinical and neurophysiological findings, a diagnosis of critical illness myopathy was made according to the current diagnostic criteria. Given the large number of patients with COVID-19 who require long ICU stays, many are very likely to develop ICU-acquired weakness, as did the patient described here. Health systems must plan to provide adequate access to rehabilitative facilities for both pulmonary and motor rehabilitative treatment after COVID-19.