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Myoglobin cast nephropathy occurs in cases of acute renal injury in which large amounts of myoglobin accumulate in the renal tubules, presenting as muscle pain, reddish-brown urine, and elevated creatine kinase levels. Our case describes a 60-year-old male who came to the emergency department with fevers, mild abdominal pain, and constitutional symptoms one day after returning to the United States from a trip to Nigeria. Initial workup demonstrated an acute kidney injury and elevated aminotransferase levels and the patient was started onatovaquone-proguanil for possible malaria given a recent diagnosis in Nigeria. Two days later, the patient was found to have rhabdomyolysis, resulting in a renal biopsy that showed myoglobin cast nephropathy. Previous literature has suggested mechanisms for the development of rhabdomyolysis in malarial infection, including inflammatory processes, direct effect of parasite accumulation, and drug-induced toxicity. Our case further implicates antimalarial therapy as a cause of rhabdomyolysis and increases awareness of myoglobin cast nephropathy as a potential complication of malaria. [ABSTRACT FROM AUTHOR]

Rationale: Robust COVID-19 outcomes classification is important for ongoing epidemiology research on acute and post-acute COVID-19 conditions. Protocolized medical record review is an established method to validate endpoints for clinical trials and cardiovascular epidemiology cohorts; however, a protocol to adjudicate hospitalizations for COVID-19 among epidemiology cohorts was lacking., Objectives: We developed a protocol to ascertain and adjudicate hospitalized COVID-19 across a meta-cohort of 14 US prospective cohort studies. This report describes the first three years of protocol implementation (October 1, 2020-October 1, 2023) and evaluates its repeatability and performance compared to classification by administrative codes., Methods: The protocol was adapted from cohort approaches to clinical cardiovascular events ascertainment and adjudication. Potential COVID-19 hospitalizations and deaths were identified by self-/proxy-report and, in some cases, active surveillance. Medical records were requested from hospitals and adjudicated for COVID-19 outcomes by clinically trained personnel according to a standardized rubric. Inter-rater agreement was assessed. The sensitivity and specificity of discharge diagnosis codes was compared to adjudicated diagnoses., Measurements and Main Results: The study obtained medical records for 1,167 potential COVID-19 hospitalizations, which underwent protocolized adjudication. Adjudication confirmed COVID-19 infection was present for 1,030 (88%) events, of which COVID-19 was not the cause of hospitalization for 78 (8%). Of 952 hospitalizations determined by adjudicators to be caused by COVID-19, 319 (34%) participants were critically ill and 210 (22%) died. Pneumonia was confirmed in 822 (86%) and acute kidney injury in 350 (37%); other cardiovascular and thrombotic complications were rare (2-5%). Interrater reliability among adjudicators was high (kappa = 0.85-1.00) except for myocardial infarction (kappa = 0.60). Compared to adjudication, sensitivity of discharge diagnosis codes was higher for pneumonia (84%) and pulmonary embolism (81%) than for other complications (48-70%)., Conclusions: Protocolized adjudication confirmed four out of five COVID-19 hospitalizations in a US meta-cohort and confirmed cases of pneumonia, pulmonary embolism, and other conditions that were not indicated by discharge diagnosis codes. These results highlight the importance of validating health outcomes for use in research on COVID-19 and post-COVID-19 conditions, and some limitations of claims-based data., Competing Interests: A Krishnaswamy left Columbia University and joined Merck (Epidemiology) as a project manager following completion of her work on this paper. Mitchell Elkind receives royalties from UpToDate for a chapter on neurological complications of COVID-19; receives study drug in kind from the BMS-Pfizer Alliance for Eliquis and ancillary funding from Roche, both for an NIH-funded trial of stroke prevention. E B Levitan receives research funding from Amgen (to UAB) unrelated to the current work and personal fees for serving on a DSMB from University of Pittsburgh for an NIH funded trial. David Schwartz is founder and chief scientific officer of Eleven P15, a company dedicated to the diagnosis, prevention, and treatment of early presentations of pulmonary fibrosis. Joyce Lee serves as a consultant for Eleven P15. Sally Wenzel receives funding for consulting and clinical trials from AstraZeneca, GSK, Sanofi-Genzyme, Novartis, Knopp; she also receives research support from Pieris and Regeneron. PG Woodruff has served as a consultant for Roche, Sanofi, Amegne and Astra Zeneca outside the context of this paper. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2025 Oelsner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To characterize patients with coronavirus disease 2019 (COVID-19) in a large New York City (NYC) medical center and describe their clinical course across the emergency department (ED), inpatient wards, and intensive care units (ICUs)., Design: Retrospective manual medical record review., Setting: NewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), a quaternary care academic medical center in NYC., Participants: The first 1000 consecutive patients with laboratory-confirmed COVID-19., Methods: We identified the first 1000 consecutive patients with a positive RT-SARS-CoV-2 PCR test who first presented to the ED or were hospitalized at NYP/CUIMC between March 1 and April 5, 2020. Patient data was manually abstracted from the electronic medical record., Main Outcome Measures: We describe patient characteristics including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition., Results: Among the first 1000 patients, 150 were ED patients, 614 were admitted without requiring ICU-level care, and 236 were admitted or transferred to the ICU. The most common presenting symptoms were cough (73.2%), fever (72.8%), and dyspnea (63.1%). Hospitalized patients, and ICU patients in particular, most commonly had baseline comorbidities including of hypertension, diabetes, and obesity. ICU patients were older, predominantly male (66.9%), and long lengths of stay (median 23 days; IQR 12 to 32 days); 78.0% developed AKI and 35.2% required dialysis. Notably, for patients who required mechanical ventilation, only 4.4% were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at 3-4 and 9 days. As of April 30, 90 patients remained hospitalized and 211 had died in the hospital., Conclusions: Hospitalized patients with COVID-19 illness at this medical center faced significant morbidity and mortality, with high rates of AKI, dialysis, and a bimodal distribution in time to intubation from symptom onset., Competing Interests: Conflict of Interest Disclosures: All authors have completed the ICMJE uniform disclosure form and declare: no support from any organization for the submitted work; no competing interests with regards to the submitted work. MMS reports grants from Amgen, outside the submitted work. JJC reports personal fees from Allergan, outside the submitted work. RGB reports grants from Alpha1 Foundation and COPD Foundation, outside the submitted work. GH reports grants from Janssen Research, outside the submitted work. The remaining authors MGA, SLB, CLS, JRT, KN, RC, MRB, BPC, NG, PG, AMM, AAP, MSR, NWS, SS, MDS, KN, PAA, FMB, RB, MFC, MIC, LAC, JHD, LBD, SAD, KAE, ZPG, DTG, AAH, NH, SH, LEK, EL, AL, AYS, ACS, ZES, CPS, YX, HWZ, and RL have nothing to disclose.