Nikhil Prasad Fact checked by:Thailand Medical News Team Sep 16, 2026 51 minutes ago
A major systematic review has brought together evidence of a rare but potentially serious form of muscle damage reported in people with SARS-CoV-2 infection and, much less frequently, following COVID-19 vaccination.
A systematic review found rhabdomyolysis reported during COVID-19 infection and in rare cases following vaccination,
although vaccine causality has not been established.
Researchers found that rhabdomyolysis—rapid destruction of skeletal muscle that releases muscle-cell contents into the bloodstream—has been documented during COVID-19, particularly among severely ill and hospitalized patients. Cases have also occurred after vaccination, but the researchers emphasized that these reports do not demonstrate that COVID-19 vaccines caused rhabdomyolysis or establish a vaccine-specific risk.
The researchers were from the CHANGE Research Working Group at Universidad Científica del Sur, Peru; Grupo de Medicina Regenerativa at Universidad Científica del Sur, Peru; the Center of Research and Medical Excellence (CRME), Peru; and Facultad de Ciencias de la Salud, Carrera de Medicina at Universidad de Aquino Bolivia, Bolivia.
Why Rhabdomyolysis Can Become Dangerous
Rhabdomyolysis occurs when damaged skeletal muscle breaks down, releasing substances including creatine kinase (CK) and myoglobin. Symptoms can include muscle pain, weakness and dark urine. Severe cases may cause acute kidney injury as released muscle components damage the kidneys.
For this
Thailand Medical News report, the researchers searched PubMed, Scopus, EMBASE and Web of Science and followed PRISMA 2020 systematic-review guidelines. Ultimately, 133 manuscripts were included: 113 case reports, seven case series and 13 observational studies.
COVID-19 Infection Cases Reveal a Serious Clinical Pattern
Among 93 case reports and seven case series involving SARS-CoV-2-associated rhabdomyolysis, researchers identified 133 patients. Their median age was 45.5 years, and 72.9% were male.
Fever was reported in 54.1%, shortness of breath in 41.4%, myalgia in 38.3% and cough in 36.8%. Importantly, 27.1% had no relevant previous medical history. Among those with underlying conditions, hypertension was reported in 32.3%, diabetes in 17.3% and obesity in 11.3%.
Laboratory findings provided a clearer picture of muscle injury. CK was elevated in 96.9% of cases, while 60.9% had elevated aspartate aminotransferase and 39.1% had elevated creatinine. Acute kidney injury or renal failure occurred in 16.5%, while 7.5% experienced cardiac complications.
Most patients—72.2%—had favorable outcomes. However, 31 of the 133 patients, or 23.3%, died. The review noted that deaths were mainly associated with complications and should not be interpreted as evidence that rhabdomyolysis itself caused every death.
Observational Studies Add Evidence From 7,766 COVID-19 Patients
The review also examined 13 observational studies involving 7,
766 COVID-19 patients, among whom 818 cases of rhabdomyolysis were reported.
Several studies found rhabdomyolysis more frequently among patients with severe COVID-19, particularly those hospitalized or admitted to intensive care. Some studies also found associations with acute kidney injury and higher mortality. However, disease severity, underlying illnesses and other confounding factors make it impossible to determine from these data whether rhabdomyolysis independently increased those risks.
The researchers therefore cautioned against treating 818 cases among 7,766 patients as a general population incidence rate. The studies differed substantially in patient populations, disease severity, clinical settings and diagnostic criteria.
Twenty Cases Reported Following COVID-19 Vaccination
The vaccination findings were based on just 20 individual case reports, making cautious interpretation especially important.
The median patient age was 52.5 years, and 75% were male. Ten cases followed the Pfizer-BioNTech BNT162b2 vaccine, four followed Moderna, four followed Oxford/AstraZeneca and one followed Johnson & Johnson; one vaccine was not reported. Fifteen of the 20 cases therefore followed an mRNA vaccine.
Half occurred after a first dose and 40% after a second dose, with two cases following later boosters. The median time between vaccination and symptoms was two days, although one patient developed symptoms within five hours.
Muscle pain and weakness were each reported in 40% of patients, while 30% developed dark urine. Every patient had elevated CK, and 25% developed acute kidney injury. Sixteen patients, or 80%, had favorable outcomes, while four died following serious complications.
Crucially, a temporal relationship does not prove causation. The authors stressed that the reported cases were exceptionally rare compared with the billions of COVID-19 vaccine doses administered worldwide, and the available evidence does not support a generalized muscle-toxic effect from mRNA vaccines.
How COVID-19 Might Damage Muscle
Researchers proposed several possible mechanisms for infection-associated rhabdomyolysis. SARS-CoV-2 can generate a powerful inflammatory response involving cytokines such as IL-1β, IL-6 and TNF-α. These inflammatory signals may interfere with muscle protein synthesis, increase oxidative stress and contribute to muscle-fiber injury.
Immune-mediated damage and molecular mimicry have also been proposed. However, the researchers emphasized that these mechanisms remain hypotheses and have not been conclusively established.
Conclusions
The findings show that rhabdomyolysis can occur in association with SARS-CoV-2 infection and deserves clinical attention, particularly when patients develop severe muscle pain, weakness, dark urine or kidney dysfunction. However, its true frequency remains uncertain because much of the evidence came from severely ill hospitalized populations. Reports following vaccination are far fewer and cannot establish causality, incidence or platform-specific risk. The findings therefore support continued clinical surveillance and further large-scale research rather than conclusions that vaccination itself causes rhabdomyolysis.
The study findings were published in the peer reviewed journal: Medicina.
https://www.mdpi.com/1648-9144/62/9/1769
Read Also:
https://www.thailandmedical.news/articles/coronavirus
https://www.thailandmedical.news/articles/long-covid
https://www.thailandmedical.news/articles/vaccine-news
Share
Tweet
Share
