Critical illness myopathy after COVID-19

Area of Science:

• Neurology
• Critical Care Medicine
• Infectious Diseases

Background:

• Coronavirus disease 2019 (COVID-19) can necessitate prolonged intensive care unit (ICU) stays.
• ICU stays are associated with the development of ICU-acquired weakness.
• Critical illness myopathy (CIM) is a potential complication in critically ill patients.

Observation:

• A patient developed diffuse and symmetrical muscle weakness following extended ICU care for COVID-19.
• Neurophysiological testing, including EMG and direct muscle stimulation (DMS), was performed.
• Findings indicated myopathy, particularly in lower limb muscles.

Findings:

• Nerve conduction studies revealed normal sensory conduction but low-amplitude compound muscle action potentials (CMAPs).
• Electromyography (EMG) showed myopathic changes.
• Post-DMS CMAP was absent in the quadriceps and reduced in the tibialis anterior, confirming CIM.

Implications:

• COVID-19 patients requiring long ICU admissions are at high risk for developing CIM and ICU-acquired weakness.
• Prompt diagnosis and management of CIM are essential for patient recovery.
• Health systems need to ensure access to comprehensive pulmonary and motor rehabilitation services for post-COVID-19 patients.