Rhabdomyolysis Reported in Association with SARS-CoV-2 Infection and COVID-19 Vaccination: A Systematic Review

Background and Objectives: The association between SARS-CoV-2 infection, COVID-19 vaccination, and the development of rhabdomyolysis remains unclear. This systematic review aimed to comprehensively synthesize and analyze the available evidence on the occurrence of rhabdomyolysis in the context of SARS-CoV-2 infection and COVID-19 vaccination. Materials and Methods: A literature search was conducted in PubMed, Scopus, EMBASE, and Web of Science. The review followed PRISMA 2020 guidelines, assessing methodological quality. Statistical analyses were performed using STATA v18. Results: A total of 133 patients with rhabdomyolysis associated with SARS-CoV-2 infection were identified from 93 case reports and 7 case series; the median age was 45.5 years (IQR: 24-62), with a predominance of males (72.9%). Additionally, 13 observational studies comprising 818 patients with rhabdomyolysis associated with SARS-CoV-2 infection were included. Among cases associated with SARS-CoV-2 vaccination, 20 patients were identified from 20 case reports; the median age was 52.5 years (IQR: 22.5-76.5), with a predominance of males (75%). These cases were primarily associated with mRNA-based vaccines, particularly Pfizer-BioNTech BNT162b2 (50%) and Moderna (20%), and occurred predominantly after the first and second doses. The most frequent clinical manifestations in both groups were fever, myalgia, and dark urine. Clinical outcomes were favorable in most patients, both among infection-associated cases (72.2%) and vaccination-associated cases (80%). Conclusions: Rhabdomyolysis has been documented during SARS-CoV-2 infection, although its true frequency remains uncertain, whereas cases following COVID-19 vaccination do not establish causality or platform-specific risks.