Keywords
Abbreviations:
MRI (magnetic resonance imaging)We read with interest the article by Kamura et al. about a 57-year-old, previously healthy male patient, who presented with leg pain 2 weeks after the first dose of the Moderna vaccine (
Kamura et al., 2022
). Four weeks after the vaccination, he was diagnosed with rhabdomyolysis upon the clinical presentation (muscle pain), elevated creatine-kinase (maximal value 74,804 U/l [n, 60-287 U/l]), and the muscle magnetic resonance imaging (MRI) (Kamura et al., 2022
). During the following course, the patient additionally developed multiorgan infarctions and, finally, died despite intensive diagnostic and therapeutic approaches (Kamura et al., 2022
). The study is interesting but raises concerns that should be discussed.The main shortcoming of the study is that an acute SARS-CoV-2 infection had not been ruled out by polymerase chain reaction. Although SARS-CoV-2 infections can be complicated by rhabdomyolysis (
Lamzouri et al., 2021
), it is crucial to rule out an acute SARS-CoV-2 infection in the index patient. Other causes of rhabdomyolysis that were not appropriately ruled out are hereditary neuromuscular disorder, seizures, food (mushrooms, coturnism), histiocytosis, insect bite, electrical shock, trauma, intoxication, or illicit drugs (Stanley et al., 2022
).To document myositis as the cause of rhabdomyolysis on muscle MRI, it is crucial to administer gadolinium. However, only a T2-image without contrast medium was presented (
Kamura et al., 2022
). Therefore, we should be informed about the results of muscle MRI with contrast medium.Because infraction can be also embolic and because endocarditis or myocarditis have been reported as a complication of SARS-CoV-2 vaccinations (
Aikawa et al., 2022
; Tiwari et al., 2022
), it is essential to know whether endocarditis and myocarditis were appropriately ruled out by echocardiography or even right ventricular myocardial biopsy or by cardiac MRI with contrast medium. In addition, we should be informed if ever during hospitalization or before hospitalization, atrial fibrillation had been recorded.The D-dimer was elevated (
Kamura et al., 2022
); therefore, we should be informed if this was attributed to an ongoing infectious disease or due to vein occlusions. Particularly, we should know whether venous sinus thrombosis, portal vein thrombosis, pulmonary embolism, mesenteric vein thrombosis, or thrombosis of the jugular veins had been appropriately ruled out.Muscle biopsy of the quadriceps muscle revealed slight rhabdomyolysis, which was not seen on muscle MRI. Which is the reason for this discrepancy?
Overall, the interesting study has some limitations and inconsistencies that call the results and their interpretation into question. Addressing these limitations could further strengthen and reinforce the statement of the study. Rhabdomyolysis requires extensive workup to uncover the underlying cause and to prevent recurrence.
Conflicts of interest
The authors have no competing interests to declare.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethical approval
The work has been approved by the institutional review board.
Availability of data
All data are available from the corresponding author.
Author contributions
JF: design, literature search, discussion, first draft, critical comments, and final approval; FS: literature search, discussion, critical comments, and final approval.
References
- Non-infectious endocarditis and myocarditis after COVID-19 mRNA vaccination.Eur Heart J Case Rep. 2022; 6: ytab533
- Fatal thrombotic microangiopathy with rhabdomyolysis as an initial symptom after the first dose of mRNA-1273 vaccine: a case report.Int J Infect Dis. 2022; 117: 322-325
- SARS-CoV-2 infection presenting as rhabdomyolysis: case report and review.J Int Med Res. 2021; 493000605211061035
- Rhabdomyolysis.StatPearls [Internet]. StatPearls Publishing, Treasure IslandFL2022 (2022 Jan–)
- Hyper-eosinophilic syndrome with myocarditis after inactivated SARS-CoV-2 vaccination - a case study.Curr Drug Saf. 2022;
Article info
Publication history
Published online: June 24, 2022
Accepted:
June 21,
2022
Received:
May 24,
2022
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© 2022 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
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