April 25, 2022
Journal of Microbiology, Immunology and Infection
National Taiwan University
Correspondence article
"Here, we present a case of fatal rhabdomyolysis and compartment syndrome after ChAdOx1-nCoV-19 vaccination.
A 44-year-old previously healthy man developed generalized myalgia after his second dose of the adenoviral-based vaccine. He presented to ER with progressive weakness and brown urine two weeks later. On admission, his blood tests showed markedly elevated creatinine, creatine kinase, and severe metabolic acidosis. His bilateral forearm and gastrocnemius muscles were tense, tender and his skin was mottled. Computed tomography revealed bilateral retroperitoneal fluid collection and swelling and edematous change of his psoas muscles...
The patient was promptly intubated and initiated on continuous venovenous hemofiltration because of severe metabolic acidosis and anuria. Emergent fasciotomy was performed over his four limbs to relieve pressure from acute compartment syndrome. Muscle biopsy revealed neutrophilic myositis and small-vessel vasculitis with fibrin thrombi and C4d deposition (Fig. 1b & c)... A heliotrope rash later developed over his eyelids... On day 5 of admission, his open fasciotomy wounds became contaminated with carbapenem-resistant Acinetobacter baumanii (CRAB) and despite maximal support and appropriate antibiotics, the patient died of CRAB sepsis and multiorgan failure on day 17...
.Our case is the first fatality to be reported among ethnic-Chinese and in a man without prior associations of advanced age, statin use, strenuous exercise, or myopathy. A proposed mechanism for post-vaccination rhabdomyolysis is an exaggerated immune response, in a predisposed individual, to previously circulating self-antigens or to released muscle-specific antigens following myonecrosis. Post-vaccination myositis, like COVID-19 associated myocarditis, may be increasingly observed because of the high antigenic similarity between the SARS-CoV-2 spike protein and human proteins."
Copyright ª 2022, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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adverse events,clinical cases,COVID-19,deaths,vaccines