Rhabdomyolysis and COVID-19 Infection: Is It Due to Statin Use or Anti-TIF1-y Antibodies?

Coronavirus disease 2019 (COVID-19), now a global pandemic, has infected millions of people and caused hundreds of thousands of deaths.  Neurological presentation of the novel coronavirus includes headaches, seizures, myalgias, hyposmia, ageusia, etc. Guillain-Barre Syndrome (GBS) and its variant, Miller Fisher Syndrome, have been reported in COVID-19 patients presenting with lower limb weakness, paresthesia, facial diplegia, and ataxia. Most recently, large vessel occlusion strokes were seen in infected younger patients without vascular risk factors. We present a novel case of rhabdomyolysis associated with COVID-19 infection in a patient on atorvastatin, in whom we detected positive anti-transcriptional intermediary factor 1 gamma antibodies (anti-TIF1-y Ab). Bilateral upper and lower extremity weakness improved with aggressive fluid administration and intravenous immunoglobulin (IVIg) at 0.4mg/kg for a total of 5 days. Interrupting a strong cytokine response with IVIg early on during the disease may have led to rapid improvement.