Muscle abnormalities worsen after post-exertional malaise in long COVID

Nat Commun. 2024 Jan 4;15(1):17. doi: 10.1038/s41467-023-44432-3.


A subgroup of patients infected with SARS-CoV-2 remain symptomatic over three months after infection. A distinctive symptom of patients with long COVID is post-exertional malaise, which is associated with a worsening of fatigue- and pain-related symptoms after acute mental or physical exercise, but its underlying pathophysiology is unclear. With this longitudinal case-control study (NCT05225688), we provide new insights into the pathophysiology of post-exertional malaise in patients with long COVID. We show that skeletal muscle structure is associated with a lower exercise capacity in patients, and local and systemic metabolic disturbances, severe exercise-induced myopathy and tissue infiltration of amyloid-containing deposits in skeletal muscles of patients with long COVID worsen after induction of post-exertional malaise. This study highlights novel pathways that help to understand the pathophysiology of post-exertional malaise in patients suffering from long COVID and other post-infectious diseases.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • COVID-19* / complications
  • Case-Control Studies
  • Fatigue / etiology
  • Humans
  • Muscle, Skeletal
  • Musculoskeletal Abnormalities*
  • Pain
  • Plaque, Amyloid
  • Post-Acute COVID-19 Syndrome
  • SARS-CoV-2

Associated data