Neuromuscular Complications of COVID-19: Evidence from the Third Year of the Global Pandemic

 

 Buy Article Permissions and Reprints

Abstract

Accumulating evidence in the third year of the global pandemic suggests that coronavirus disease 2019 (COVID-19) can cause neuromuscular complications during or after the acute phase of infection. Direct viral infection and immune-mediated mechanisms have been hypothesized. Furthermore, in patients with underlying autoimmune neuromuscular diseases, COVID-19 infection may trigger a disease flare. COVID-19 vaccines appear to be safe and effective at preventing severe illness from COVID-19. Certain vaccines are associated with an increased risk of Guillain-Barré syndrome and possibly Bell's palsy, but the absolute incidence is low, and benefits likely outweigh the risks. Newer prophylactic therapies and treatments are also becoming available for patients who may not mount a sufficient response to vaccination or have contraindications. In this article, we discuss the current available evidence on neuromuscular complications of COVID-19 and clinical considerations regarding vaccination.

Publication History

Article published online:
31 March 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

• References

• 1 Araújo NM, Ferreira LC, Dantas DP. et al. First report of SARS-CoV-2 detection in cerebrospinal fluid in a child with Guillain-Barré syndrome. Pediatr Infect Dis J 2021; 40 (07) e274-e276
  CrossrefPubMedGoogle Scholar
• 2 Gutiérrez-Ortiz C, Méndez-Guerrero A, Rodrigo-Rey S. et al. Miller Fisher syndrome and polyneuritis cranialis in COVID-19. Neurology 2020; 95 (05) e601-e605
  CrossrefPubMedGoogle Scholar
• 3 Petrelli C, Scendoni R, Paglioriti M, Logullo FO. Acute motor axonal neuropathy related to COVID-19 infection: a new diagnostic overview. J Clin Neuromuscul Dis 2020; 22 (02) 120-121
  CrossrefPubMedGoogle Scholar
• 4 Civardi C, Collini A, Geda DJ, Geda C. Antiganglioside antibodies in Guillain-Barré syndrome associated with SARS-CoV-2 infection. J Neurol Neurosurg Psychiatry 2020; 91 (12) 1361-1362
  CrossrefPubMedGoogle Scholar
• 5 Dalakas MC. Guillain-Barré syndrome: the first documented COVID-19-triggered autoimmune neurologic disease: more to come with myositis in the offing. Neurol Neuroimmunol Neuroinflamm 2020; 7 (05) e781
  CrossrefPubMedGoogle Scholar
• 6 Fantini J, Di Scala C, Chahinian H, Yahi N. Structural and molecular modelling studies reveal a new mechanism of action of chloroquine and hydroxychloroquine against SARS-CoV-2 infection. Int J Antimicrob Agents 2020; 55 (05) 105960
  CrossrefPubMedGoogle Scholar
• 7 Zhou P, Yang XL, Wang XG. et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579 (7798): 270-273
  CrossrefPubMedGoogle Scholar
• 8 Lu H, Yan P, Xiong W, Wang J, Liu X. Genomic characterization of a novel virulent phage infecting Shigella flexneri and isolated from sewage. Virus Res 2020; 283: 197983
  CrossrefPubMedGoogle Scholar
• 9 Lucchese G, Flöel A. SARS-CoV-2 and Guillain-Barré syndrome: molecular mimicry with human heat shock proteins as potential pathogenic mechanism. Cell Stress Chaperones 2020; 25 (05) 731-735
  CrossrefPubMedGoogle Scholar
• 10 Morsy S. NCAM protein and SARS-COV-2 surface proteins: in-silico hypothetical evidence for the immunopathogenesis of Guillain-Barré syndrome. Med Hypotheses 2020; 145: 110342
  CrossrefPubMedGoogle Scholar
• 11 Keddie S, Pakpoor J, Mousele C. et al. Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barré syndrome. Brain 2021; 144 (02) 682-693
  CrossrefPubMedGoogle Scholar
• 12 Miró Ò, Llorens P, Jiménez S. et al; Spanish Investigators in Emergency Situations TeAm (SIESTA) network. Frequency of five unusual presentations in patients with COVID-19: results of the UMC-19-S₁ . Epidemiol Infect 2020; 148: e189
  CrossrefPubMedGoogle Scholar
• 13 Patone M, Handunnetthi L, Saatci D. et al. Neurological complications after first dose of COVID-19 vaccines and SARS-CoV-2 infection. Nat Med 2021; 27 (12) 2144-2153
  CrossrefPubMedGoogle Scholar
• 14 Luijten LWG, Leonhard SE, van der Eijk AA. et al; IGOS Consortium. Guillain-Barré syndrome after SARS-CoV-2 infection in an international prospective cohort study. Brain 2021; 144 (11) 3392-3404
  CrossrefPubMedGoogle Scholar
• 15 Garnero M, Del Sette M, Assini A. et al. COVID-19-related and not related Guillain-Barré syndromes share the same management pitfalls during lock down: the experience of Liguria region in Italy. J Neurol Sci 2020; 418: 117114
  CrossrefPubMedGoogle Scholar
• 16 Gigli GL, Bax F, Marini A. et al. Guillain-Barré syndrome in the COVID-19 era: just an occasional cluster?. J Neurol 2021; 268 (04) 1195-1197
  CrossrefPubMedGoogle Scholar
• 17 Filosto M, Cotti Piccinelli S, Gazzina S. et al. Guillain-Barré syndrome and COVID-19: an observational multicentre study from two Italian hotspot regions. J Neurol Neurosurg Psychiatry 2021; 92 (07) 751-756
  CrossrefPubMedGoogle Scholar
• 18 Umapathi T, Er B, Koh JS, Goh YH, Chua L. Guillain-Barré syndrome decreases in Singapore during the COVID-19 pandemic. J Peripher Nerv Syst 2021; 26 (02) 235-236
  CrossrefPubMedGoogle Scholar
• 19 Lunn MP, Carr AC, Keddie S, Pakpoor J, Pipis M, Willison HJ. Reply: Guillain-Barré syndrome, SARS-CoV-2 and molecular mimicry and Ongoing challenges in unravelling the association between COVID-19 and Guillain-Barré syndrome and Unclear association between COVID-19 and Guillain-Barré syndrome and currently available data regarding the potential association between COVID-19 and Guillain-Barré syndrome. Brain 2021; 144 (05) e47
  CrossrefPubMedGoogle Scholar
• 20 Oaklander AL, Mills AJ, Kelley M. et al. Peripheral neuropathy evaluations of patients with prolonged long COVID. Neurol Neuroimmunol Neuroinflamm 2022; 9 (03) e1146
  CrossrefPubMedGoogle Scholar
• 21 Scala I, Bellavia S, Luigetti M. et al. Autonomic dysfunction in non-critically ill COVID-19 patients during the acute phase of disease: an observational, cross-sectional study. Neurol Sci 2022; 43 (08) 4635-4643
  CrossrefPubMedGoogle Scholar
• 22 Odozor CU, Kannampallil T, Ben Abdallah A. et al. Post-acute sensory neurological sequelae in patients with severe acute respiratory syndrome coronavirus 2 infection: the COVID-PN observational cohort study. Pain 2022; 163 (12) 2398-2410
  CrossrefPubMedGoogle Scholar
• 23 Abrams RMC, Simpson DM, Navis A, Jette N, Zhou L, Shin SC. Small fiber neuropathy associated with SARS-CoV-2 infection. Muscle Nerve 2022; 65 (04) 440-443
  CrossrefPubMedGoogle Scholar
• 24 Novak P, Mukerji SS, Alabsi HS. et al. Multisystem involvement in post-acute sequelae of coronavirus disease 19. Ann Neurol 2022; 91 (03) 367-379
  CrossrefPubMedGoogle Scholar
• 25 Barizien N, Le Guen M, Russel S, Touche P, Huang F, Vallée A. Clinical characterization of dysautonomia in long COVID-19 patients. Sci Rep 2021; 11 (01) 14042
  CrossrefPubMedGoogle Scholar
• 26 Shiers S, Ray PR, Wangzhou A. et al. ACE2 and SCARF expression in human dorsal root ganglion nociceptors: implications for SARS-CoV-2 virus neurological effects. Pain 2020; 161 (11) 2494-2501
  CrossrefPubMedGoogle Scholar
• 27 Suh J, Mukerji SS, Collens SI. et al. Skeletal muscle and peripheral nerve histopathology in COVID-19. Neurology 2021; 97 (08) e849-e858
  CrossrefPubMedGoogle Scholar
• 28 Márquez Loza AM, Holroyd KB, Johnson SA, Pilgrim DM, Amato AA. Guillain-Barré syndrome in the placebo and active arms of a COVID-19 vaccine clinical trial: temporal associations do not imply causality. Neurology 2021; DOI: 10.1212/wnl.0000000000011881.
  CrossrefPubMedGoogle Scholar
• 29 Woo EJ, Mba-Jonas A, Dimova RB, Alimchandani M, Zinderman CE, Nair N. Association of receipt of the Ad26.COV2.S COVID-19 vaccine with presumptive Guillain-Barré syndrome, February-July 2021. JAMA 2021; 326 (16) 1606-1613
  CrossrefPubMedGoogle Scholar
• 30 Hanson KE, Goddard K, Lewis N. et al. Incidence of Guillain-Barré syndrome after COVID-19 vaccination in the Vaccine Safety Datalink. JAMA Netw Open 2022; 5 (04) e228879
  CrossrefPubMedGoogle Scholar
• 31 Atzenhoffer M, Auffret M, Pegat A. et al. Guillain-Barré syndrome associated with COVID-19 vaccines: a perspective from spontaneous report data. Clin Drug Investig 2022; 42 (07) 581-592
  CrossrefPubMedGoogle Scholar
• 32 Keh RYS, Scanlon S, Datta-Nemdharry P. et al; BPNS/ABN COVID-19 Vaccine GBS Study Group. COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database. Brain 2023; 146 (02) 739-748
  CrossrefPubMedGoogle Scholar
• 33 Maramattom BV, Krishnan P, Paul R. et al. Guillain-Barré syndrome following ChAdOx1-S/nCoV-19 vaccine. Ann Neurol 2021; 90 (02) 312-314
  CrossrefPubMedGoogle Scholar
• 34 Osowicki J, Morgan H, Harris A, Crawford NW, Buttery JP, Kiers L. Guillain-Barré syndrome in an Australian state using both mRNA and adenovirus-vector SARS-CoV-2 vaccines. Ann Neurol 2021; 90 (05) 856-858
  CrossrefPubMedGoogle Scholar
• 35 Rosenblum HG, Hadler SC, Moulia D. et al. Use of COVID-19 vaccines after reports of adverse events among adult recipients of Janssen (Johnson & Johnson) and mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna): update from the Advisory Committee on Immunization Practices - United States, July 2021. MMWR Morb Mortal Wkly Rep 2021; 70 (32) 1094-1099
  CrossrefPubMedGoogle Scholar
• 36 COVID-19 Vaccine Safety Update. Vaxzevria AstraZeneca AB. European Medicines Agency. Updated September 2021. Accessed August 30, 2022 at: https://www.ema.europa.eu/en/documents/covid-19-vaccine-safety-update/covid-19-vaccine-safety-update-vaxzevria-previously-covid-19-vaccine-astrazeneca-8-september-2021_en.pdf
  PubMed
• 37 COVID-19 Vaccine Safety Update. COVID-19 vaccine Janssen. European Medicines Agency. Updated August 11, 2021. Accessed August 30, 2022 at: https://www.ema.europa.eu/en/documents/covid-19-vaccine-safety-update/covid-19-vaccine-safety-update-covid-19-vaccine-janssen-11-august-2021_en.pdf
  PubMed
• 38 Vaccine Considerations for People Who Are Moderately or Severely Immunocompromised. Centers for Disease Control and Prevention. Updated September 2, 2022. Accessed September 2, 2022 at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html#:∼:text=If%20you%20are%20moderately%20or%20severely%20immunocompromised%20or%20severely%20allergic,you%20from%20getting%20COVID%2D19
  PubMed
• 39 Shapiro Ben David S, Potasman I, Rahamim-Cohen D. Rate of recurrent Guillain-Barré syndrome after mRNA COVID-19 vaccine BNT162b2. JAMA Neurol 2021; 78 (11) 1409-1411
  CrossrefPubMedGoogle Scholar
• 40 Wan EYF, Chui CSL, Lai FTT. et al. Bell's palsy following vaccination with mRNA (BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines: a case series and nested case-control study. Lancet Infect Dis 2022; 22 (01) 64-72
  CrossrefPubMedGoogle Scholar
• 41 Ozonoff A, Nanishi E, Levy O. Bell's palsy and SARS-CoV-2 vaccines-an unfolding story - authors' reply. Lancet Infect Dis 2021; 21 (09) 1211-1212
  CrossrefPubMedGoogle Scholar
• 42 Sato K, Mano T, Niimi Y, Toda T, Iwata A, Iwatsubo T. Facial nerve palsy following the administration of COVID-19 mRNA vaccines: analysis of a self-reporting database. Int J Infect Dis 2021; 111: 310-312
  CrossrefPubMedGoogle Scholar
• 43 Shemer A, Pras E, Einan-Lifshitz A, Dubinsky-Pertzov B, Hecht I. Association of COVID-19 vaccination and facial nerve palsy: a case-control study. JAMA Otolaryngol Head Neck Surg 2021; 147 (08) 739-743
  CrossrefPubMedGoogle Scholar
• 44 Shasha D, Bareket R, Sikron FH. et al. Real-world safety data for the Pfizer BNT162b2 SARS-CoV-2 vaccine: historical cohort study. Clin Microbiol Infect 2022; 28 (01) 130-134
  CrossrefPubMedGoogle Scholar
• 45 Renoud L, Khouri C, Revol B. et al. Association of facial paralysis with mRNA COVID-19 vaccines: a disproportionality analysis using the World Health Organization Pharmacovigilance Database. JAMA Intern Med 2021; 181 (09) 1243-1245
  CrossrefPubMedGoogle Scholar
• 46 Gummi RR, Kukulka NA, Deroche CB, Govindarajan R. Factors associated with acute exacerbations of myasthenia gravis. Muscle Nerve 2019; 60 (06) 693-699
  CrossrefPubMedGoogle Scholar
• 47 Businaro P, Vaghi G, Marchioni E. et al. COVID-19 in patients with myasthenia gravis: epidemiology and disease course. Muscle Nerve 2021; 64 (02) 206-211
  CrossrefPubMedGoogle Scholar
• 48 Solé G, Mathis S, Friedman D. et al. Impact of coronavirus disease 2019 in a French cohort of myasthenia gravis. Neurology 2021; 96 (16) e2109-e2120
  CrossrefPubMedGoogle Scholar
• 49 Roy B, Kovvuru S, Nalleballe K, Onteddu SR, Nowak RJ. Electronic health record derived-impact of COVID-19 on myasthenia gravis. J Neurol Sci 2021; 423: 117362
  CrossrefPubMedGoogle Scholar
• 50 Kim Y, Li X, Huang Y. et al. COVID-19 outcomes in myasthenia gravis patients: analysis from electronic health records in the United States. Front Neurol 2022; 13: 802559
  CrossrefPubMedGoogle Scholar
• 51 Muppidi S, Guptill JT, Jacob S. et al; CARE-MG Study Group. COVID-19-associated risks and effects in myasthenia gravis (CARE-MG). Lancet Neurol 2020; 19 (12) 970-971
  CrossrefPubMedGoogle Scholar
• 52 Jakubíková M, Týblová M, Tesař A. et al. Predictive factors for a severe course of COVID-19 infection in myasthenia gravis patients with an overall impact on myasthenic outcome status and survival. Eur J Neurol 2021; 28 (10) 3418-3425
  CrossrefPubMedGoogle Scholar
• 53 Felten R, Duret PM, Bauer E. et al. B-cell targeted therapy is associated with severe COVID-19 among patients with inflammatory arthritides: a 1-year multicentre study in 1116 successive patients receiving intravenous biologics. Ann Rheum Dis 2022; 81 (01) 143-145
  CrossrefPubMedGoogle Scholar
• 54 Simpson AI, Vaghela KR, Brown H. et al. Reducing the risk and impact of brachial plexus injury sustained from prone positioning - a clinical commentary. J Intensive Care Med 2020; 35 (12) 1576-1582
  CrossrefPubMedGoogle Scholar
• 55 Salter A, Fox RJ, Newsome SD. et al. Outcomes and risk factors associated with SARS-CoV-2 infection in a North American Registry of patients with multiple sclerosis. JAMA Neurol 2021; 78 (06) 699-708
  CrossrefPubMedGoogle Scholar
• 56 Malas MB, Naazie IN, Elsayed N, Mathlouthi A, Marmor R, Clary B. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: a systematic review and meta-analysis. EClinicalMedicine 2020; 29: 100639
  CrossrefPubMedGoogle Scholar
• 57 Hoang P, Hurtubise B, Muppidi S. Clinical reasoning: therapeutic considerations in myasthenic crisis due to COVID-19 infection. Neurology 2020; 95 (18) 840-843
  CrossrefPubMedGoogle Scholar
• 58 Stahl K, Bode C, David S. First do no harm-beware the risk of therapeutic plasma exchange in severe COVID-19. Crit Care 2020; 24 (01) 363
  CrossrefPubMedGoogle Scholar
• 59 Jacob S, Muppidi S, Guidon A. et al; International MG/COVID-19 Working Group. Guidance for the management of myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) during the COVID-19 pandemic. J Neurol Sci 2020; 412: 116803
  CrossrefPubMedGoogle Scholar
• 60 Živković SA, Gruener G, Narayanaswami P. AANEM Quality and Patient Safety Committee. Doctor-Should I get the COVID-19 vaccine? Infection and immunization in individuals with neuromuscular disorders. Muscle Nerve 2021; 63 (03) 294-303
  CrossrefPubMedGoogle Scholar
• 61 Farina A, Falso S, Cornacchini S. et al. Safety and tolerability of SARS-CoV-2 vaccination in patients with myasthenia gravis: a multicenter experience. Eur J Neurol 2022; 29 (08) 2505-2510
  CrossrefPubMedGoogle Scholar
• 62 Ishizuchi K, Takizawa T, Sekiguchi K. et al. Flare of myasthenia gravis induced by COVID-19 vaccines. J Neurol Sci 2022; 436: 120225
  CrossrefPubMedGoogle Scholar
• 63 Lotan I, Hellmann MA, Friedman Y, Stiebel-Kalish H, Steiner I, Wilf-Yarkoni A. Early safety and tolerability profile of the BNT162b2 COVID-19 vaccine in myasthenia gravis. Neuromuscul Disord 2022; 32 (03) 230-235
  CrossrefPubMedGoogle Scholar
• 64 Reyes-Leiva D, López-Contreras J, Moga E. et al. Immune response and safety of SARS-CoV-2 mRNA-1273 vaccine in patients with myasthenia gravis. Neurol Neuroimmunol Neuroinflamm 2022;9(4):e200002
  PubMedGoogle Scholar
• 65 Fact Sheet for Patients, Parents and Caregivers. Emergency Use Authorization (EUA) of EVUSHELD™ (tixagevimab co-packaged with cilgavimab) for Coronavirus Disease 2019 (COVID-19). AstraZeneca. Accessed March 5, 2023 at: https://www.fda.gov/media/154702/download
  PubMed
• 66 Ruddy JA, Connolly CM, Boyarsky BJ. et al. High antibody response to two-dose SARS-CoV-2 messenger RNA vaccination in patients with rheumatic and musculoskeletal diseases. Ann Rheum Dis 2021; 80 (10) 1351-1352
  CrossrefPubMedGoogle Scholar
• 67 Bitoun S, Avouac J, Henry J. et al. Very low rate of humoral response after a third COVID-19 vaccine dose in patients with autoimmune diseases treated with rituximab and non-responders to two doses. RMD Open 2022; 8 (01) 8
  CrossrefPubMedGoogle Scholar
• 68 Jyssum I, Kared H, Tran TT. et al. Humoral and cellular immune responses to two and three doses of SARS-CoV-2 vaccines in rituximab-treated patients with rheumatoid arthritis: a prospective, cohort study. Lancet Rheumatol 2022; 4 (03) e177-e187
  CrossrefPubMedGoogle Scholar
• 69 Fact Sheet for Patients, Parents, and Caregivers. Emergency Use Authorization (EUA) of Paxlovid for Coronavirus Disease 2019 (COVID-19). Pfizer Labs. Updated August 26, 2022. Accessed August 30, 2022 at: https://www.fda.gov/media/155051/download
  PubMed
• 70 Romero-Sánchez CM, Díaz-Maroto I, Fernández-Díaz E. et al. Neurologic manifestations in hospitalized patients with COVID-19: the ALBACOVID registry. Neurology 2020; 95 (08) e1060-e1070
  CrossrefPubMedGoogle Scholar
• 71 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
  CrossrefPubMedGoogle Scholar
• 72 Chen N, Zhou M, Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223): 507-513
  CrossrefPubMedGoogle Scholar
• 73 Li LQ, Huang T, Wang YQ. et al. COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol 2020; 92 (06) 577-583
  CrossrefPubMedGoogle Scholar
• 74 Borges do Nascimento IJ, Cacic N, Abdulazeem HM. et al. Novel coronavirus infection (COVID-19) in humans: a scoping review and meta-analysis. J Clin Med 2020; 9 (04) 9
  CrossrefPubMedGoogle Scholar
• 75 Wang D, Hu B, Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323 (11) 1061-1069
  CrossrefPubMedGoogle Scholar
• 76 Mao L, Jin H, Wang M. et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020; 77 (06) 683-690
  CrossrefPubMedGoogle Scholar
• 77 Guan WJ, Ni ZY, Hu Y. et al; China Medical Treatment Expert Group for COVID-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382 (18) 1708-1720
  CrossrefPubMedGoogle Scholar
• 78 Geng Y, Ma Q, Du YS. et al. Rhabdomyolysis is associated with in-hospital mortality in patients with COVID-19. Shock 2021; 56 (03) 360-367
  CrossrefPubMedGoogle Scholar
• 79 Haroun MW, Dieiev V, Kang J. et al. Rhabdomyolysis in COVID-19 patients: a retrospective observational study. Cureus 2021; 13 (01) e12552
  PubMedGoogle Scholar
• 80 Manzano GS, Woods JK, Amato AA. COVID-19-associated myopathy caused by Type I interferonopathy. N Engl J Med 2020; 383 (24) 2389-2390
  CrossrefPubMedGoogle Scholar
• 81 Zhang H, Charmchi Z, Seidman RJ, Anziska Y, Velayudhan V, Perk J. COVID-19-associated myositis with severe proximal and bulbar weakness. Muscle Nerve 2020; 62 (03) E57-E60
  CrossrefPubMedGoogle Scholar
• 82 Tanboon J, Nishino I. COVID-19-associated myositis may be dermatomyositis. Muscle Nerve 2021; 63 (01) E9-E10
  CrossrefPubMedGoogle Scholar
• 83 Okada Y, Izumi R, Hosaka T. et al. Anti-NXP2 antibody-positive dermatomyositis developed after COVID-19 manifesting as type I interferonopathy. Rheumatology (Oxford) 2022; 61 (04) e90-e92
  CrossrefPubMedGoogle Scholar
• 84 Aschman T, Schneider J, Greuel S. et al. Association between SARS-CoV-2 infection and immune-mediated myopathy in patients who have died. JAMA Neurol 2021; 78 (08) 948-960
  CrossrefPubMedGoogle Scholar
• 85 Shi Z, de Vries HJ, Vlaar APJ. et al; Dutch COVID-19 Diaphragm Investigators. Diaphragm pathology in critically ill patients with COVID-19 and postmortem findings from 3 medical centers. JAMA Intern Med 2021; 181 (01) 122-124
  CrossrefPubMedGoogle Scholar
• 86 Hooper JE, Uner M, Priemer DS, Rosenberg A, Chen L. Muscle biopsy findings in a case of SARS-CoV-2-associated muscle injury. J Neuropathol Exp Neurol 2021; 80 (04) 377-378
  CrossrefPubMedGoogle Scholar
• 87 Dodig D, Tarnopolsky MA, Margeta M, Gordon K, Fritzler MJ, Lu JQ. COVID-19-associated critical illness myopathy with direct viral effects. Ann Neurol 2022; 91 (04) 568-574
  CrossrefPubMedGoogle Scholar
• 88 Rodriguez B, Branca M, Gutt-Will M. et al. Development and early diagnosis of critical illness myopathy in COVID-19 associated acute respiratory distress syndrome. J Cachexia Sarcopenia Muscle 2022; 13 (03) 1883-1895
  CrossrefPubMedGoogle Scholar
• 89 Frithiof R, Rostami E, Kumlien E. et al. Critical illness polyneuropathy, myopathy and neuronal biomarkers in COVID-19 patients: a prospective study. Clin Neurophysiol 2021; 132 (07) 1733-1740
  CrossrefPubMedGoogle Scholar
• 90 Tankisi H, Tankisi A, Harbo T, Markvardsen LK, Andersen H, Pedersen TH. Critical illness myopathy as a consequence of COVID-19 infection. Clin Neurophysiol 2020; 131 (08) 1931-1932
  CrossrefPubMedGoogle Scholar
• 91 Gil-Vila A, Ravichandran N, Selva-O'Callaghan A. et al; COVAD Study Group. COVID-19 Vaccination in Autoimmune Diseases (COVAD) study: vaccine safety in idiopathic inflammatory myopathies. Muscle Nerve 2022; 66 (04) 426-437
  CrossrefPubMedGoogle Scholar
• 92 Connolly CM, Ruddy JA, Boyarsky BJ. et al. Disease flare and reactogenicity in patients with rheumatic and musculoskeletal diseases following two-dose SARS-CoV-2 messenger RNA vaccination. Arthritis Rheumatol 2022; 74 (01) 28-32
  CrossrefPubMedGoogle Scholar
• 93 Conticini E, d'Alessandro M, Grazzini S. et al. Relapses of idiopathic inflammatory myopathies after vaccination against COVID-19: a real-life multicenter Italian study. Intern Emerg Med 2022; 17 (07) 1921-1928
  CrossrefPubMedGoogle Scholar