COVID-19 precipitated sarcopenia in a patient with COPD and initially preserved functional status

ABSTRACT

Case: We report a case of a 67-year-old man with COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade B, who developed significant sarcopenia following a mild COVID-19 infection. Prior to infection, the patient had preserved functional capacity, with a 6-minute walk distance (6MWD) of 420 meters. During the acute phase, he experienced mild respiratory symptoms managed entirely on an outpatient basis. Three weeks post-infection, he had marked proximal muscle weakness, reduced handgrip strength (21 kg), slow gait speed (0.9 m/s), and decreased 6MWD (290 m). Laboratory evaluation revealed elevated creatine phosphokinase (CPK 420 U/L) and lactate dehydrogenase (LDH 280 U/L), persistent mild lymphopenia, and low-grade systemic inflammation. Serum 25-hydroxyvitamin D, albumine and calcium levels were within normal ranges. Immunological work-up for inflammatory myopathy, including antinuclear antibodies (ANA) and anti–Jo-1 (anti–histidyl-tRNA synthetase) antibodies, was negative. A structured rehabilitation program, including respiratory therapy, postural exercises, low-intensity resistance training, and optimized protein intake (1.2–1.5 g/kg/day), was initiated.

Outcome: Over 12 months, the patient demonstrated progressive recovery of muscle strength, functional capacity, and normalization of most laboratory parameters, with residual mild proximal weakness.

Conclusion: This case underscores that COVID-19 can precipitate or unmask sarcopenia even after mild respiratory illness in COPD patients with previously preserved functional status. Systematic muscle assessment and early rehabilitation, including nutritional optimization, are essential to preserve functional independence in this vulnerable population.

Keywords: COVID-19, COPD, Sarcopenia, Muscle weakness, Handgrip strength, Rehabilitation