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Resident PGY 1
Henry Ford Hospital
An otherwise healthy 42-year-old male presented with lower back pain and thigh pain. On presentation, he was found to have a CPK of 4100 and a creatinine of 2.99 (baseline 1). Lumbar x-ray was negative for an acute process. Urine drug screen was negative. However, repeat CPK revealed a CPK of 313,000 and a creatinine of 4.11. Upon further questioning, the patient denied any sort of trauma or injury. Given concern for crackles that were heard on exam, chest x-ray was completed and revealed multifocal opacities. The patient denied any sort of respiratory symptoms, however given that the patient presented during the COVID-19 pandemic, he was tested. Remarkably, the test was positive. Given the lack of symptoms, Infectious Disease recommended against treatment with Hydroxychloroquine. He was treated aggressively with IV fluids as his creatinine continued to rise and eventually peaked at 9.3. Given that the patient continued to have good urine output and his CPK dropped below 5,000, he was deemed stable for discharge home after 9 days. Throughout his stay, he did not develop signs or symptoms of respiratory distress nor other classic signs of COVID-19. This case illustrates an atypical presentation of COVID-19. In the setting of a global pandemic of a novel disease, it demonstrates the necessity of keeping an open differential and understanding that there may be many different clinical manifestations of a virus that is still poorly understood.
Singh-Kucukarslan, Gulmohar and Heidemann, Danielle, "Atypical Presentation of COVID-19 causing Rhabdomyolysis: a case report" (2020). Case Reports. 17.