Case report, case study

https://doi.org/10.21860/medflum2022_284701

Critical illness myopathy and polyneuropathy in a patient with severe COVID -19 infection – a case report

Adelmo Šegota ; Klinički bolnički centar Rijeka, Zavod za fizikalnu i rehabilitacijsku medicinu, Rijeka, Hrvatska
Katarina Šarić ; Klinički bolnički centar Rijeka, Zavod za fizikalnu i rehabilitacijsku medicinu, Rijeka, Hrvatska
Matea Bagatin ; Klinički bolnički centar Rijeka, Zavod za fizikalnu i rehabilitacijsku medicinu, Rijeka, Hrvatska
Dunja Mršić ; Klinički bolnički centar Rijeka, Zavod za fizikalnu i rehabilitacijsku medicinu, Rijeka, Hrvatska
Mario Stahović ; Klinički bolnički centar Rijeka, Zavod za fizikalnu i rehabilitacijsku medicinu, Rijeka, Hrvatska
Nino Zahirović ; Klinički bolnički centar Rijeka, Zavod za fizikalnu i rehabilitacijsku medicinu, Rijeka, Hrvatska

Abstract

Aim: The aim of this paper is to present a patient with severe COVID-19 infection who has developed critical illness myopathy and polyneuropathy (CRYMNE), with severe functional disability as well as the rehabilitation process, with a review of literature. Case report: A 58-year-old patient develops a severe form of COVID-19 infection with the development of acute respiratory failure due to bilateral COVID-19 pneumonia. Due to the worsening of the clinical condition, he is mechanically ventilated, develops septic shock and is treated with polypharmacological therapy with supportive treatment and gradually progressive rehabilitation. Upon improvement of clinical status, the patient becomes vital and hemodynamically stable, on oxygen supplementation of 4L/min. Due to the development of critical-illness related myopathy and neuropathy (CRYMNE) and the consequent generalized severe muscle weakness with severe disability, he started post- COVID-19 multidisciplinary rehabilitation according to an individual rehabilitation program (IRP). IRP consists of respiratory and neuromuscular rehabilitation, and rehabilitation of the training function in everyday life activities. According to the performed IRP, the patient is free of shortness of breath and fatigue. Oxygen saturation is persistent and there is no reason for further oxygen therapy. Progress in rehabilitation outcomes is monitored by functional tools and a reduction in joint pain, strengthening of muscle strength of large muscle groups, increase in the grip strength of both hands and reduction of general fatigue are registered. The patient walks independently with a walker and peroneal orthoses due to residual paresis of both peroneal nerves. Functional independence indexes as assessment tools of function have also been improved, which is proof of a better quality of life. Conclusion: CRYMNE is the consequence of complex pathophysiological mechanisms due to long-term, life-threatening disease with the development of severe disability and loss of function. The individual rehabilitation program is implemented continuously, adjusted to the severity of the clinical condition under supervision of a multidisciplinary team.

Keywords

COVID-19; muscular diseases; polyneuropathies; sarcopenia

Hrčak ID:

284701

URI

https://hrcak.srce.hr/284701

Publication date:

1.12.2022.

Article data in other languages: croatian

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