<scp>COVID</scp>‐19‐Associated Critical Illness Myopathy with Direct Viral Effects

Coronavirus disease 2019 (COVID‐19) severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2 infection) can lead to intensive care unit (ICU) admission and critical illness myopathy (CIM). We examined 3 ICU patients with COVID‐19 who required mechanical ventilation for pneumonia and developed CIM. Pathological examination of the skeletal muscle biopsies revealed myopathic changes consistent with CIM, variable inflammation with autophagic vacuoles, SARS‐CoV immunostaining + fibers/granules, and electron microscopy findings of mitochondrial abnormalities and coronavirus‐like particles. Although mitochondrial dysfunction with compromised energy production is a critical pathogenic mechanism of non‐COVID‐19‐associated CIM, in our series of COVID‐19‐associated CIM, myopathic changes including prominent mitochondrial damage suggest a similar mechanism and association with direct SARS‐CoV‐2 muscle infection. ANN NEUROL 2022;91:568–574

COVID‐19‐Associated Critical Illness Myopathy with Direct Viral Effects Journal Articles