Pediatric COVID-19-associated rhabdomyolysis: a case report

• Published in: Pediatric nephrology (Berlin, West) Vol. 35; no. 8; pp. 1517 - 1520
• Main Authors: Gefen, Ashley M., Palumbo, Nancy, Nathan, Suresh K., Singer, Pamela S., Castellanos-Reyes, Laura J., Sethna, Christine B.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2020; Springer; Springer Nature B.V
• Subjects: Adolescent; Betacoronavirus; Care and treatment; Case reports; Case studies; Complications and side effects; Coronavirus Infections - complications; Coronavirus Infections - diagnosis; Coronaviruses; COVID-19; Creatine Kinase - blood; Creatinine; Diagnosis; Fever; Humans; Intravenous administration; Male; Medicine; Medicine & Public Health; Myalgia; Myalgia - etiology; Nephrology; Pandemics; Pediatric research; Pediatrics; Pneumonia, Viral - complications; Pneumonia, Viral - diagnosis; Rapid Communication; Rhabdomyolysis; Rhabdomyolysis - blood; Rhabdomyolysis - diagnosis; Rhabdomyolysis - etiology; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Sodium bicarbonate; Urine; Urology; United States; SARS-CoV-2; Coronavirus; Children; Creatine kinase
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-020-04617-0

COVID-19 is the illness caused by infection with the novel coronavirus SARS-CoV-2. Although myalgia is common in adults, it has not been noted as a common symptom in children. There have been a few reported cases of COVID-19-associated rhabdomyolysis in adults. This case report describes a 16-year-old boy who presented with fever, myalgias, mild shortness of breath with exertion, and dark-colored urine. COVID-19 PCR was positive. His initial creatinine kinase (CK) level was 427,656 U/L. Serum creatinine was normal for age. He was treated with isotonic intravenous fluids containing sodium bicarbonate to maintain urine output of 100–200 mL/h and urine pH > 7.0. His serum creatinine remained normal throughout the hospital stay and he was discharged on hospital day 12 with a CK of 6526 U/L. To our knowledge, no pediatric cases of COVID-19-associated rhabdomyolysis have been previously reported. Adult cases of rhabdomyolysis have been reported and a few reports have noted patients with elevated CK levels without rhabdomyolysis. Given this pediatric case of COVID-19-associated rhabdomyolysis, pediatric clinicians should be aware of this complication and manage fluids appropriately in order to prevent acute kidney injury.