Salivary Osteopontin as a Potential Biomarker for Oral Mucositis

Osteopontin (OPN), a multifunctional phosphoglycoprotein also presents in saliva, plays a crucial role in tumour progression, inflammation and mucosal protection. Mucosal barrier injury due to high-dose conditioning regimen administered during autologous and allogeneic peripheral stem cell transplantation (APSCT) has neither efficient therapy nor established biomarkers. Our aim was to assess the biomarker role of OPN during APSCT, with primary focus on oral mucositis (OM). Serum and salivary OPN levels were determined by ELISA in 10 patients during APSCT at four stages of transplantation (day −3/−7, 0, +7, +14), and in 23 respective healthy controls. Results: There was a negative correlation between both salivary and serum OPN levels and grade of OM severity during APSCT (r = −0.791, p = 0.019; r = −0.973, p = 0.001). Salivary OPN increased at days +7 (p = 0.011) and +14 (p = 0.034) compared to controls. Among patients, it was higher at day +14 compared to the time of admission (day −3/−7) (p = 0.039) and transplantation (day 0) (p = 0.011). Serum OPN remained elevated at all four stages of transplantation compared to controls (p = 0.013, p = 0.02, p = 0.011, p = 0.028). During APSCT elevated salivary OPN is a potential non-invasive biomarker of oral mucositis whereas the importance of high serum OPN warrants further studies.

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Defibrotide for Prophylaxis of Hepatic Veno-Occlusive Disease in Autologous, Non-Purged Peripheral Stem Cell Transplantation for High Risk Neuroblastoma Patients

Blood ◽

10.1182/blood.v124.21.5910.5910 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5910-5910

Author(s):

Emel Unal ◽

Nurdan Tacyildiz ◽

Gulsan Yavuz ◽

Handan Dincaslan ◽

Gulsah Tanyildiz ◽

...

Keyword(s):

Stem Cell ◽

High Risk ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Conflicts Of Interest ◽

Conditioning Regimen ◽

Occlusive Disease ◽

High Dose ◽

Peripheral Stem Cell ◽

Peripheral Stem Cell Transplantation

Abstract High-dose chemotherapy (HDC) represents the standard of treatment for high-risk neuroblastoma(NBL), hepatic veno-occlusive disease (VOD) is a common, 10-50% and serious complication of haematological stem cell transplantation (HSCT), with up to 90% mortality rates. We planned study to assess whether the use of prophylactic defibrotide in paediatric patients who were heavily treated with chemo-radiotherapy before transplant, and then underwent autologous HSCT. Seventeen patients who underwent autologous, unpurged peripheral stem cell transplantation PBSC with a high risk of developing VOD, between January 2003-July 2014, were given Defibrotide prophylaxis 25mg/kg/day for 30 days, commencing on -1 of conditioning regimen. All patients were stratified by INSS stage, age, N-MYC status. All were treated with six cycles of induction chemotherapy, myeloablative intensification, surgery for primary site, radiation therapy to the primary tumour site plus metastatic sites i.e bone metastases including skull. Meta-iodobenzylguanidin treatment as targeted radiotherapy was given on -21 prior to myeloablative chemotherapy. Oral 13-cis retinoic acid was employed on day +90 post-transplant. CD34+ cell mobilization and PBSC collection was carreid out after two-four cycles of induction cycles. Conditioning regimen and stem cell infusion was done following four-six weeks of last chemotherapy cycle, in order to reduce the toxicitiy. Conditioning regimen CEM consisted Carboplatin, Etoposide, Melfalan. There were no toxic deaths. All of the patients receieved antimicrobial prophylaxis and total parenteral nutrition support when was needed. Myeloid engraftment on day+13, erythroid engraftment on day+18 and thrombocyte engraftment was achieved on day +23. Defibrotide prophylaxis seems to reduce incidence of VOD and is well tolerated. VOD incidence and severity was reduced in the defibrotide group which suggests that defibrotide might be effective in preventing and treating VOD. Sufficiently powered randomised trials are now required to definitively test the role of defibrotide in this setting. Disclosures No relevant conflicts of interest to declare.

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Impact of oral mucositis on outcomes of multiple myeloma patients treated with high-dose melphalan conditioning and autologous stem cell transplantation (ASCT).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.7037 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 7037-7037

Author(s):

Graziella Chagas Jaguar ◽

Gustavo Henrique Rodrigues ◽

Andre Guollo ◽

Vanessa Oliveira Camandoni ◽

Leila Maria Magalhães Pessoa Melo ◽

...

Keyword(s):

Multiple Myeloma ◽

Parenteral Nutrition ◽

Clinical Outcomes ◽

Oral Mucositis ◽

Conditioning Regimen ◽

High Dose ◽

Pharmacokinetic Studies ◽

Oral Pain ◽

Grade 3 ◽

High Dose Melphalan

7037 Background: High-dose melphalan is the standard conditioning regimen for patients with multiple myeloma (MM) undergoing ASCT. However, this therapy is commonly associated with severe oral mucositis (OM). Low-level laser therapy (LLLT) has been reported as an effective method in preventing this complication. The aim of this study was to define the potential impact of OM on outcomes in patients with MM undergoing ASCT and receiving preventive LLLT. Methods: We describe a retrospective cohort of 79 consecutive patients with MM who received high-dose melphalan conditioning. All patients received prophylactic LLLT application performed daily from the beginning of the conditioning regimen up to day +2. The patients continued receiving LLLT in case of OM grade ≥ 2 until complete remission of the lesions. OM severity was assessed daily using WHO scale from the beginning of conditioning until hospital discharge. We examined the relationship between worst OM grade and clinical outcomes, including days with oral pain, days of total parenteral nutrition, days of LLLT and days with neutropenic fever. Results: Of 79 patients, 55 (69.62%) experienced OM grade 0-1, 16 (20.25%) experienced OM grade 2, 7 (8.86%) grade 3 and 1 (1.26%) grade 4. Patients with OM grade 0-2 had statistically fewer days of oral pain compared with grade 3-4 (0.88 and 6.25 days, respectively, p = 0.0001). The worst OM grade was also significantly (p < 0.05) associated with days of narcotic therapy and length of LLLT. Severe OM was not associated with febrile days or the use of parenteral nutrition. Conclusions: Severe OM is associated with worse clinical outcomes. In this transplantation setting, severe OM was not common as previously reported in literature, probably due to LLLT. Controlled randomized trials should be performed to confirm the real benefit of LLLT in this scenario as well as the pharmacogenomics and pharmacokinetic studies to better understand interpatient variability of melphalan exposure and toxicity.

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Final analysis of the phase II, randomized, double-blind, placebo-controlled trial of single dose velafermin (CG53135–05) for the prevention of oral mucositis

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.6537 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 6537-6537 ◽

Cited By ~ 4

Author(s):

M. W. Schuster ◽

E. Anaissie ◽

D. Hurd ◽

W. Bensinger ◽

J. Mason ◽

...

Keyword(s):

Stem Cell ◽

Single Dose ◽

Phase Ii ◽

Oral Mucositis ◽

Conditioning Regimen ◽

Study Drug ◽

High Dose ◽

Cell Transplant ◽

Hematopoietic Stem ◽

Grade 3

6537 Background: Oral mucositis (OM) is a commonly occurring side effect of high-dose chemotherapy (HDCT) in patients (pts) undergoing autologous hematopoietic stem cell transplant (AHSCT). Velafermin, recombinant human fibroblast growth factor 20, is being investigated for prevention of OM. Velafermin promotes epithelial and mesenchymal cell proliferation in vitro and in vivo. Methods: A phase II trial was conducted to evaluate safety, efficacy, and pharmacokinetics (PK) of velafermin. Inclusion criteria: pts undergoing HDCT and AHSCT with or without total body irradiation (TBI) were enrolled. Velafermin at 0.03, 0.1, or 0.2 mg/kg or placebo was administered as single dose IV at 24h after stem cell infusion. Safety and PK were assessed. Pts were scored daily for presence of OM using the WHO grading scale. The primary endpoint was the incidence of Grade 3/4 OM. Results: A total of 212 pts were randomized to either placebo (n=51) or velafermin at 0.03 (n=50), 0.1 (n=56), or 0.2 (n=55) mg/kg (intent-to-treat or ITT sample). 206 pts (97%) received study drug or placebo. Pt diagnoses included multiple myeloma (57%), non-Hodgkin’s (25%), or Hodgkin’s (11%) lymphoma and 13 pts (6%) received TBI as part of the conditioning regimen. The Grade 3/4 OM incidence rates (%) in the placebo or velafermin arms (0.03, 0.1, and 0.2 mg/kg) were 37, 18, 38, and 36, respectively. The primary analysis of dose dependent reduction of severe OM was not statistically significant (p = 0.549). However, velafermin at 0.03 mg/kg did reduce the incidence of Grade 3/4 OM when compared to placebo alone (p = 0.031). Duration of Grade 3/4 OM was reduced significantly in the 0.03 mg/kg when every pt was evaluated or in the 0.1 mg/kg dose when only pts with Grade 3/4 OM were included in the analysis (p = 0.037 and 0.014, respectively). A total of 5 related SAEs (3 in 0.1 mg/kg, 1 in 0.03 mg/kg, and 1 in placebo cohort) occurred within 4hr of study drug infusion. All symptoms were transient. Conclusion: Single dose velafermin at 0.03mg/kg is may be active in reducing CT induced severe OM in AHSCT pts. Safety profile supports continuing study to define the optimal dose for prevention of severe OM. A new Phase II study will be conducted to confirm velafermin activity at 0.03mg/kg dose. [Table: see text]

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Prevention of Oral Mucositis with Palifermin in Patients Treated with High-Dose Chemotherapy and Autologous Stem Cell Transplantation. A Single Center Experience.

Blood ◽

10.1182/blood.v108.11.2974.2974 ◽

2006 ◽

Vol 108 (11) ◽

pp. 2974-2974

Author(s):

Francois Luthi ◽

Lorenzo Berwert ◽

Valérie Frossard ◽

Oscar Marchetti ◽

Anne Rosselet ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Autologous Stem Cell Transplantation ◽

Oral Mucositis ◽

Conditioning Regimen ◽

High Dose Chemotherapy ◽

High Dose ◽

Group A ◽

Grade 3 ◽

Group B

Abstract It was demonstrated in a placebo controlled randomized study that Palifemin decrease the severity of oral mucositis in patients (pts) treated with total body irradiation (TBI), high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT). The benefit of this treatment in pts who are not receiving TBI-containing conditioning regimen is still unclear. We evaluated prospectively the effect of Palifermin on mucositis prevention in 34 consecutive pts treated with HDCT and ASCT compared to an historical group of pts who did not receive Palifermin. Between 03/2005 and 05/2006, 34 pts (Group A) treated with Melphalan 200 (n=15) or BEAM (n=19) gave informed consent and received 6 injections of 0.06 mg/kg of Palifermin (3 days (d.) before HDCT and 3 d. following ASCT). Four were excluded from efficacy analysis, 2 of them due to Melphalan dose reduction and 2 due to early discontinuation of Palifermin. They were compared to 77 pts (Group B) treated with Melphalan 200 (n=43) or BEAM (n=34) from 2003 to 2005. WHO grading was used for toxicity assessment. The median age was 55 years in group A (Range 28–67) and 54 years in group B (Range 19–66). The median count of CD34 cells/kg infused was 4.2 millions (Range 1.96–23.9) in group A and 3.85 millions (Range 1.8–16.2) in group B. The median time for engraftment was the same in both groups and was respectively 11 d. for neutrophils (Range 8–12) and 11 d. for platelets (Range 8–13) in group A, 11 d. for neutrophils (Range 8–13) and 11 d. for platelets (Range 8–18) in group B. Severe oral mucositis (Grade 3 and 4) was lower in group A (17%) than in group B (44%). The incidence of grade 2 or more digestive mucositis was similar in the 2 groups (66% vs.60%) as well as the total opioid use (43% vs 57%). All patients but one in the group B developed fever. Fever of unknown origin were more frequent in group A due to less fever attributed to grade 3 or 4 mucositis.In group A, all but 3 pts developed toxicities. Grade 3 or 4 toxicities consisted in erythematous rash in 15 pts (44%), generalized oedema in 2 and odynophagia in 1. Grade 1 or 2 toxicities were pruritis (24%), rash (32%), localized oedema (26%) and buccal discomfort (41%). 1 pt died at d.12 from an hemophagocytic syndroma and onother at d.90 from a rapidly progressive colorectal cancer. We conclude that the use of Palifermin reduced the incidence of grade 3 or 4 mucositis in our group of pts treated without TBI, but did not decrease either digestive mucositis or the use of morphinic. The benefit of Palifermin on mucositis prevention has still to be balanced again the risk of discomfort and toxicities of this drug. Large randomized studies are still needed before recommending the systematic administration of Palifermin to pts receiving Melphalan 200 or BEAM as conditioning regimen before ASCT.

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Efficacy, Safety and Tolerability of Biotene Mouthwash Versus Aloe Vera Juice and Active Manuka Honey for Prophylaxis of Oral Mucositis Following Chemoradiotheray

Blood ◽

10.1182/blood.v112.11.4703.4703 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4703-4703

Author(s):

Kian Meng Chang ◽

Tee Chuan Ong ◽

Sen Mui Tan ◽

Swee Kim Tan

Keyword(s):

Oral Mucositis ◽

Secondary Infection ◽

Interleukin 1 ◽

Conditioning Regimen ◽

Aloe Vera ◽

Nutrition Support ◽

High Dose ◽

Manuka Honey ◽

Necrosis Factor Alpha ◽

Hematopoietic Stem

Abstract Background: Oral mucositis (OM) is a common and debilitating complication following high dose Methotrexate (MTX) as well as conditioning regimen for hematopoietic stem cell transplantation (HSCT). The mucosal injury varies in severity, ranging from mild inflammation to full thickness mucosal ulceration extending into submucosal layer. In the setting of damaged mucosal layer and neutropenia, secondary infection may happen which can lead to systemic sepsis. The vicious cycle of inflammation and secondary sepsis will trigger greater release of cytokines, such as tumor necrosis factor alpha and interleukin 1 beta that further worsen the mucosal insult. Patients who develop OM not only suffer from pain and poor quality of life but also infections which can be life-threatening. Obviously, OM causes increased duration of hospital stay, use of parenteral narcotics and nutrition support with increased treatment costs. Currently, there are no definitive approved methods/agents except Palifermin (Keratinocyte growth factor, KGF) that can prevent and/or reduce the severity, incidence and duration of OM. However, the use of Palifermin in our centre is constrained by its cost. Therefore, we explored the feasibility of locally available cheaper agents such as Biotene mouthwash, and the Aloe Vera juice and active Manuka Honey. Biotene mouthwash is alcohol free and contains antibacterial enzymes that reduce bacterial growth, oral irritation and promote gingival health. Aloe barbodensis inner leaf juice and honey is claimed to contain nutrients, minerals and vitamins. Patients and Methods: A total of 76 patients were enrolled between September 2007 and February 2008. Application of Biotene mouthwash was done every 6 hourly whereas Aloe Vera juice was consumed twice a day. All HSCT patients received oral Ciprofloxacin, Acyclovir and Fluconazole until Day +21 as prophylaxis. Patients receiving high dose MTX were hyperhydrated with urinary alkalinization. The degree of mucositis was assessed daily by nurses using the WHO grading of mucositis. Physicians were allowed to prescribe intravenous narcotics, analgesics and TPN and ICU care as required. Patients were requested to filll a self reported OM daily questionnaire based on usual analogue scale. Results: A total of 46 patients received Biotene mouthwash and 30 patients received Aloe Vera juice. 29/46 (63%) vs. 13/30 (43.3%) received high dose MTX in the Biotene arm and Aloe Vera juice arm, respectively, whereas 17/46 (37%) vs. 17/30 (56.7%) received HSCT. The prevalence of grade 0, 1–2, 3–4 mucositis in patients received Biotene mouth wash and Aloe Vera juice are 17.4%, 52.2%, 30.4% and 26.7%, 56.7%, 16.7% respectively (Chi Square for trend, p = 0.145). Requirement for intravenous opioid was 0/46(0%) vs. 4/30(13.3), and TPN requirement was 0/46(0%) vs. 2/30(6.7). None of the patients required ICU management. Conclusions: Biotene mouthwash is similar to Aloe Vera juice in reducing/preventing the severity of mucositis in patient underwent MTX or conditioning regimen for HSCT. Both are safe and well tolerated. The can be considered as useful local measures in the prophylaxis of OM following chemoradiotheray.

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Randomised controlled trial of conditioning regimen for cord blood transplantation for adult myeloid malignancies comparing high-dose cytarabine/cyclophosphamide/total body irradiation with versus without G-CSF priming: G-CONCORD study protocol

BMJ Open ◽

10.1136/bmjopen-2020-040467 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040467

Author(s):

Seitaro Terakura ◽

Takaaki Konuma ◽

Masatsugu Tanaka ◽

Yukiyasu Ozawa ◽

Makoto Onizuka ◽

...

Keyword(s):

Cord Blood ◽

Study Protocol ◽

Total Body Irradiation ◽

Graft Failure ◽

Cord Blood Transplantation ◽

Conditioning Regimen ◽

High Dose ◽

Blood Transplantation ◽

Total Body ◽

Randomised Controlled

IntroductionA better long-term quality of life after umbilical cord blood transplantation (CBT) is observed compared with transplants from other alternative donors, whereas graft failure and relapses after CBT are still major issues. To minimise graft failure and relapse after CBT, intensification of conditioning by the addition of high-dose cytosine arabinoside (CA) and concomitant continuous use of granulocyte-colony stimulating factor (G-CSF) are reported to convey a significantly better survival after CBT in some retrospective studies. To confirm the effect of G-CSF plus CA combination, in addition to the standard conditioning regimen, cyclophosphamide (CY)/total body irradiation (TBI), we design a randomised controlled study comparing CA/CY/TBI with versus without G-CSF priming (G-CSF combined conditioned cord blood transplantation [G-CONCORD] study).Methods and analysisThis is a multicentre, open-label, randomised phase III study that aimed to compare G-CSF+CA/CY/TBI as a conditioning regimen for CBT with CA/CY/TBI. Patients with acute myeloid leukaemia or myelodysplastic syndrome, aged 16–55 years, are eligible. The target sample size is 160 and the registration period is 4 years. The primary endpoint is the 2-year disease-free survival rate after CBT. The secondary endpoints are overall survival, relapse, non-relapse mortality, acute and chronic graft-versus-host disease, engraftment rate, time to neutrophil recovery, short-term adverse events, incidence of infections and causes of death.This study employs a single one-to-one web-based randomisation between the with-G-CSF versus without-G-CSF groups after patient registration. Combination of high-dose CA and CY/TBI in both groups is used for conditioning.Ethics and disseminationThe study protocol was approved by the central review board, Nagoya University Certified Review Board, after the enforcement of the Clinical Trials Act in Japan. The manuscripts presenting data from this study will be submitted for publication in quality peer-reviewed medical journals. Study findings will be disseminated via presentations at national/international conferences and peer-reviewed journals.Trial registration numbersUMIN000029947 and jRCTs041180059.

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Oral mucositis in patients with acute myeloid leukemia treated with allogeneic hematopoietic stem cell transplantation in relation to the conditioning used prior to transplantation

Annals of Hematology ◽

10.1007/s00277-021-04568-y ◽

2021 ◽

Author(s):

Aleksandra Wysocka-Słowik ◽

Lidia Gil ◽

Zuzanna Ślebioda ◽

Agnieszka Kręgielczak ◽

Barbara Dorocka-Bobkowska

Keyword(s):

Acute Myeloid Leukemia ◽

Cell Transplantation ◽

Oral Mucositis ◽

Myeloid Leukemia ◽

Hematopoietic Cell Transplantation ◽

Conditioning Regimen ◽

World Health ◽

Post Transplantation ◽

Hematopoietic Stem ◽

Acute Myeloid

AbstractThis study was designed to investigate the frequency and severity of oral mucositis in patients with acute myeloid leukemia after allogeneic hematopoietic cell transplantation, in relation to the type of conditioning used. Eighty patients diagnosed with acute myeloid leukemia were assigned to two groups based on the conditioning regimen used before transplantation. The intensity of oral inflammatory lesions induced by chemotherapy (oral mucositis) was evaluated according to a 5-point scale recommended by World Health Organization. Oral mucosa was investigated in all patients before the transplantation and during two subsequent stages of the post-transplantation procedure in relation to the conditioning regimen used. Mucositis in the oral cavity was observed in the majority of patients (66%) in the first week after transplantation, whereas the largest percentage of patients suffering oral lesions (74%) occurred in the second week after transplantation. A significantly higher percentage of patients with mucositis was observed in the group which underwent myeloablation therapy (74% of MAC and 50% of RIC patients in the first week; 83% of MAC and 53% of RIC patients in the second examination).The severity of mucositis after transplantation was higher in the MAC patients compared to the RIC patients. The highest mean value of the mucositis index was recorded in the second week in the MAC group (1.59). In AML sufferers receiving allo-HSCT, oral mucositis is a significant complication of the transplantation. This condition is more frequent and more severe in patients after treatment with myeloablation therapy.

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Busulfan plus melphalan versus melphalan alone conditioning regimen after bortezomib based triplet induction chemotherapy for patients with newly diagnosed multiple myeloma

Therapeutic Advances in Hematology ◽

10.1177/20406207211012985 ◽

2021 ◽

Vol 12 ◽

pp. 204062072110129

Author(s):

Songyi Park ◽

Dong-Yeop Shin ◽

Junshik Hong ◽

Inho Kim ◽

Youngil Koh ◽

...

Keyword(s):

Multiple Myeloma ◽

Induction Chemotherapy ◽

Statistical Significance ◽

Conditioning Regimen ◽

Progression Free Survival ◽

High Dose ◽

Newly Diagnosed ◽

Cell Engraftment ◽

The Difference ◽

High Dose Melphalan

Background: High dose melphalan (HDMEL) is considered the standard conditioning regimen for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients. Recent studies showed superiority of busulfan plus melphalan (BUMEL) compared to HDMEL as a conditioning regimen. We compared the efficacy of HDMEL and BUMEL in newly diagnosed Asian MM patients, who are often underrepresented. Methods: This is a single-center, retrospective study including MM patients who underwent ASCT after bortezomib-thalidomide-dexamethasone (VTD) triplet induction chemotherapy between January 2015 and August 2019. Result: In the end, 79 patients in the HDMEL group were compared to 31 patients in the BUMEL group. There were no differences between the two groups with regards to sex, age at ASCT, risk group, and stage. The HDMEL group showed better response to pre-transplant VTD compared to BUMEL, but after ASCT the BUMEL group showed better overall response. In terms of progression-free survival (PFS), although BUMEL showed trends towards better PFS regardless of pre-transplant status and age, the difference did not reach statistical significance. The BUMEL group more often experienced mucositis related to chemotherapy, but there was no difference between the two groups with regards to hospitalization days, cell engraftment, and infection rates. Conclusion: BUMEL conditioning deserves attention as the alternative option to HDMEL for newly diagnosed MM patients, even in the era of triplet induction chemotherapy. Specifically, patients achieving very good partial response (VGPR) or better response with triplet induction chemotherapy might benefit the most from BUMEL conditioning. Tailored conditioning regimen, based on patient’s response to induction chemotherapy and co-morbidities, can lead to better treatment outcomes.

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Severe acute myopathy following SARS-CoV-2 infection: a case report and review of recent literature

Skeletal Muscle ◽

10.1186/s13395-021-00266-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Badrul Islam ◽

Mohiuddin Ahmed ◽

Zhahirul Islam ◽

S. M. Begum

Keyword(s):

High Serum ◽

High Dose ◽

Limb Weakness ◽

Case Presentation ◽

Skeletal Myopathy ◽

Potential Marker ◽

Ventilatory Failure ◽

Muscle Magnetic Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

Dose Corticosteroid

Abstract Background SARS-CoV2 virus could be potentially myopathic. Serum creatinine phosphokinase (CPK) is frequently found elevated in severe SARS-CoV2 infection, which indicates skeletal muscle damage precipitating limb weakness or even ventilatory failure. Case presentation We addressed such a patient in his forties presented with features of severe SARS-CoV2 pneumonia and high serum CPK. He developed severe sepsis and acute respiratory distress syndrome (ARDS) and received intravenous high dose corticosteroid and tocilizumab to counter SARS-CoV2 associated cytokine surge. After 10 days of mechanical ventilation (MV), weaning was unsuccessful albeit apparently clear lung fields, having additionally severe and symmetric limb muscle weakness. Ancillary investigations in addition with serum CPK, including electromyogram, muscle biopsy, and muscle magnetic resonance imaging (MRI) suggested acute myopathy possibly due to skeletal myositis. Conclusion We wish to stress that myopathogenic medication in SARS-CoV2 pneumonia should be used with caution. Additionally, serum CPK could be a potential marker to predict respiratory failure in SARS-CoV2 pneumonia as skeletal myopathy affecting chest muscles may contribute ventilatory failure on top of oxygenation failure due to SARS-CoV2 pneumonia.

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