Skeletal Muscles Injury Related to SARS-CoV-2 Infection: A Case Report


  • Anak Agung Ayu Putri Laksmidewi Department of Neurology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
  • Maria Oktaviany Gabur Department of Neurology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
  • Carolin Tiara Lestari Indah Department of Neurology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia



neurological manifestation, skeletal muscle injury, myalgia, renal damage, SARS-CoV-2, case report


BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease related to coronavirus (SARS-CoV-2) which is categorized as Nidovirales order, family beta-coronaviridae. Coronavirus infects mainly the lung as well as other organs out of the lung. Extrapulmonary infection includes neurological infection such as the central nervous system, peripheral nervous system, and musculoskeletal with various symptoms. Recent study reported that 30% of patients had COVID-19-associated skeletal muscle injury.

CASE PRESENTATION: A 78-year-old male with a history of stroke and Type 2 diabetes mellitus came to the emergency department with fever, shortness of breath, decrease of consciousness, joints, and muscles pain. Chest X-ray showed a consolidation in the mid-lower of the lung bilaterally, with prominent bronchovascular markings, polymerase chain reaction COVID-19 result comes out with positive 2 times with 10 days interval. The patient is treated with antibiotics, Avigan, azithromycin, and high-dose intravenous Vitamin C. In the 3rd ward day, the patient still has short of breathiness. However, fever and consciousness improve, but still complaining of pain in the shoulder joint, arm muscles, and knee joint. On the 11th inpatient day, the patient obtains full consciousness; dyspnea improved, no fever, however, the patient still complains of muscle and joint pain. At the end of the inpatient period fever, dyspnea and consciousness seem to be improved; however, the patient still complains of pain in the shoulder joint, arm muscles, and knee joint that not improved with an analgesic. The patient comes back to his home in good condition.

CONCLUSION: COVID-19 patients may develop musculoskeletal symptoms such as skeletal injury or myalgia, and this is our first case of COVID-19 infection complicated with skeletal muscle injury.


Download data is not yet available.


Metrics Loading ...

Plum Analytics Artifact Widget Block


Xu T, Chen C, Zhu Z, Cui M, Chen C, Dai H, et al. Clinical features and dynamics of viral load in imported and non-imported patients with COVID-19. Int J Infect Dis. 2020;64:68- 71. PMid:32179140

World Health Organization. Coronavirus Disease (COVID-19) Outbreak. Geneva: World Health Organization; 2019. Available from: [Last accessed on 2020 Oct 07].

Abdullahi A, Candan SA, Abba MA, Bello AH, Alshehri MA, Victor EA, et al. Neurological and musculoskeletal features of COVID-19: A systematic review and meta-analysis. Front Neurol. 2020;11:687. PMid:32676052

Cipollaro L, Giordano L, Padulo J, Oliva F, Maffulli N. Musculoskeletal symptoms in SARS-CoV-2 (COVID-19) patients. J Orthop Surg Res. 2020;15(1):178. PMid:32423471

Dewi VT, Laksmidewi AA, Sudiarini KA. Clinical manifestation and pathogenesis of nervous system involvement in severe acute respiratory syndrome Coronavirus-2 infection. Asian J Pharm Clin Res. 2020;13(10):23-8.

Wan S, Xiang Y, Fang W, Zheng Y, Li B, Hu Y, et al. Clinical features and treatment of COVID-19 patients in Northeast Chongqing. J Med Virol. 2020;92(7):797-806. PMid:32198776

Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with Coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683- 90. PMid:32275288

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. S0140-6736(20)30183-5

Kucuk A, Cure MC, Cure E. Can COVID-19 cause myalgia with a completely different mechanism? A hypothesis. Clin Rheumatol. 2020;39(7):2103-4. s10067-020-05178-1 PMid:32458242

Sahin AR, Erdogan A, Agaoglu PM, Dineri Y, Cakirci AY, Senel ME, et al. 2019 novel Coronavirus (COVID-19) outbreak: A review of the current literature. Eurasian J Med Oncol. 2020;4(1):1-7.

Cure E, Cure MC. Comment on organ-protective effect of angiotensin-converting enzyme 2 and its effect on the prognosis

of COVID-19. J Med Virol. 2020;92(9):1423-4. PMid:32266994

Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631-7. PMid:15141377

Cozzi D, Albanesi M, Cavigli E, Moroni C, Bindi A, Luvara S, et al. Chest X-ray in new Coronavirus disease 2019 (COVID- 19) infection: Findings and correlation with clinical outcome. Radiol Med. 2020;125(8):730-7. s11547-020-01232-9 PMid:32519256

Cleverley J, Piper J, Jones MM. The role of chest radiography in confirming COVID-19 pneumonia. BMJ. 2020;370:m2426. PMid:32675083

Carr AC, Maggini S. Vitamin C and immune function. Nutrients. 2017;9(11):1211. PMid:29099763

Dong L, Hu S, Gao J. Discovering drugs to treat Coronavirus disease 2019 (COVID-19). Drug Discov Ther. 2020;14(1):58-60. PMid:32147628

Cai Q, Yang M, Liu D, Chen J, Shu D, Xia J, et al. Experimental treatment with favipiravir for COVID-19: An open-label control study. Engineering (Beijing). 2020;6(10):1192-8. PMid:32346491

NICE. COVID-19 Rapid Guideline: Antibiotics for Pneumonia in Adults in Hospital; 2020. Available from: uk/terms-and-conditions#notice-ofrights. [Last accessed on 2020 Oct 07].




How to Cite

Laksmidewi AAAP, Gabur MO, Indah CTL. Skeletal Muscles Injury Related to SARS-CoV-2 Infection: A Case Report. Open Access Maced J Med Sci [Internet]. 2021 Feb. 18 [cited 2021 Sep. 20];9(C):34-9. Available from:



Case Report in Internal Medicine


Most read articles by the same author(s)