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

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.

Severe Acute Myopathy Following SARS-CoV-2 Infection: A Case Report and Review of Recent Literature

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. Ancilliary 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 oxygenetion failure due to SARS-CoV2 pneumonia.

Multi-Steps Registration Protocol for Multimodal MR Images of Hip Skeletal Muscles in a Longitudinal Study

Image registration is crucial in multimodal longitudinal skeletal muscle Magnetic Resonance Imaging (MRI) studies to extract reliable parameters that can be used as indicators for physio/pathological characterization of muscle tissue and for assessing the effectiveness of treatments. This paper aims at proposing a reliable registration protocol and evaluating its accuracy in a longitudinal study. The hips of 6 subjects were scanned, in a multimodal protocol, at 2 different time points by a 3 Tesla scanner; the proposed multi-step registration pipeline is based on rigid and elastic transformations implemented in SimpleITK using a multi-resolution technique. The effects of different image pre-processing (muscle masks, isotropic voxels) and different parameters’ values (learning rates and mesh sizes) were quantitatively assessed using standard accuracy indexes. Rigid registration alone does not provide satisfactory accuracy for inter-sessions alignment and a further elastic step is needed. The use of isotropic voxels, combined with the muscle masking, provides the best result in terms of accuracy. Learning rates can be increased to speed up the process without affecting the final results. The protocol described in this paper, complemented by open-source software, can be a useful guide for researchers that approach for the first time the issues related to the muscle MR image registration.

Four Individuals with a Homozygous Mutation in Exon 1f of the PLEC Gene and Associated Myasthenic Features

We identified the known c.1_9del mutation in the PLEC gene in four unrelated females from consanguineous families of Turkish origin. All individuals presented with slowly progressive limb-girdle weakness without any dermatological findings, and dystrophic changes observed in their muscle biopsies. Additionally, the neurological examination revealed ptosis, facial weakness, fatigability, and muscle cramps in all four cases. In two patients, repetitive nerve stimulation showed a borderline decrement and a high jitter was detected in all patients by single-fiber electromyography. Clinical improvement was observed after treatment with pyridostigmine and salbutamol was started. We further characterize the phenotype of patients with limb-girdle muscular dystrophy R17 clinically, by muscle magnetic resonance imaging (MRI) features and by describing a common 3.8 Mb haplotype in three individuals from the same geographical region. In addition, we review the neuromuscular symptoms associated with PLEC mutations and the role of plectin in the neuromuscular junction.