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COVID ‐19‐Associated Critical Illness Myopathy with Direct Viral Effects
Author(s) -
Dodig Dubravka,
Tarnopolsky Mark A.,
Margeta Marta,
Gordon Katerina,
Fritzler Marvin J.,
Lu JianQiang
Publication year - 2022
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.26318
Subject(s) - covid-19 , critical illness , medicine , virology , myopathy , betacoronavirus , coronavirus infections , critically ill , disease , outbreak , infectious disease (medical specialty)
Coronavirus disease 2019 (COVID‐19) severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2 infection) can lead to intensive care unit (ICU) admission and critical illness myopathy (CIM). We examined 3 ICU patients with COVID‐19 who required mechanical ventilation for pneumonia and developed CIM. Pathological examination of the skeletal muscle biopsies revealed myopathic changes consistent with CIM, variable inflammation with autophagic vacuoles, SARS‐CoV immunostaining + fibers/granules, and electron microscopy findings of mitochondrial abnormalities and coronavirus‐like particles. Although mitochondrial dysfunction with compromised energy production is a critical pathogenic mechanism of non‐COVID‐19‐associated CIM, in our series of COVID‐19‐associated CIM, myopathic changes including prominent mitochondrial damage suggest a similar mechanism and association with direct SARS‐CoV‐2 muscle infection. ANN NEUROL 2022;91:568–574