A severe myopathy case in aged patient treated with high statin dosage

Abstract

Statins (S) are widely used drugs for cardiovascular prevention however their utilization may cause a various grade of muscle toxicity. Sometime S discontinuation alone is not sufficient to revert muscle injury and this can evolve in serious inflammatory muscle disease. In this case immunosuppressive medications are required to achieve remission. This case report describes a patient who developed rhabdomyolysis after recent S treatment initiation and the diagnostic work up have lead to the diagnosis of necrotizing autoimmune myopathy (NAM). We believe that the clinical case described here is a useful report of this rare toxicity and we aim to highlight the importance of its prompt recognition and treatment.

Keywords: Enzyme; Inflammatory disease; Myopathy; Rhabdomyolysis; Statin.

Fig. 1

Incisional biopsy from skeletal muscle of the buttock. (A) Low magnification showing necrosis (*) of some skeletal muscle cells. (B) Higher magnification showing necrotic cells (*) scattered among normal-appearing skeletal muscle cells. Inflammatory infiltrate and fibrosis are lacking.

Fig. 2

Muscle oedema on fluid-sensitive MRI sequences. Axial T2-weighted (a) and fat-suppressed T2-weighted (b) MR images show diffuse increased signal intensity of the left gluteus maximum muscle (white arrows). Axial T2-weighted (c) and fat-suppressed T2-weighted (d) MR images show atrophy and increased signal intensity of the right and left semitendinosus muscles (white arrows).