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Case Reports
. 2019 Dec 14;9(6):503-506.
doi: 10.1080/20009666.2019.1702272. eCollection 2019.

Statin-induced necrotizing autoimmune myopathy: an extremely rare adverse effect from statin use

Priyadarshani Sharma  1 , Bidhya Timilsina  1 , Janak Adhikari  2 , Prem Parajuli  1 , Rashmi Dhital  1 , Niranjan Tachamo  1
Affiliations
Case Reports

Statin-induced necrotizing autoimmune myopathy: an extremely rare adverse effect from statin use

Priyadarshani Sharma et al. J Community Hosp Intern Med Perspect. .

Abstract

Statins are widely prescribed medications to prevent cardiovascular events. While self-limited statin myopathy is relatively common, statin-induced necrotizing autoimmune myopathy (SINAM) is extremely uncommon, with incidence of two cases per million per year. We present a case of SINAM after a decade of atorvastatin use, leading to debilitating weakness. A 71-year-old male presented with recurrent falls due to extreme bilateral lower-extremity weakness without pain or sensory changes. No fever, chills, rash, joint pain, recent infection or medication changes were reported. Reported taking atorvastatin 80 mg daily for 10 years. Physical examination revealed significant muscle wasting on right deltoid and proximal muscle weakness in all extremities. Lab tests included elevated creatinine kinase, aldolase, ESR, CRP and transaminases. Anti-HMGCR antibody was significantly elevated. TSH, serum protein electrophoresis and RPR were unremarkable. ANA, Anti-Jo-1, anti-Mi2, anti-SRP, anti-ds-DNA, anti-SSA and anti-SSB antibodies were negative. MRI of thigh revealed diffuse myositis. Electromyogram revealed an acute myopathic process. Muscle biopsy showed muscle necrosis and C5b-9 sarcolemmal deposits on non-necrotic fibers without rimmed vacuoles. He was diagnosed with SINAM. Statin was discontinued, and steroid, immunoglobulins and azathioprine were started with gradual improvement. Unlike the self-limiting statin myopathy, SINAM is more severe and is associated with significant proximal muscle weakness, markedly elevated CK and persistent symptoms despite statin discontinuation. Anti-HMGCR antibodies are present in 100% of cases. Immunosuppressants are the mainstay of treatment, and statin rechallenge should never be done in these cases. Although relatively rare, physicians should be cognizant of SINAM.

Keywords: Statin-induced necrotizing autoimmune myopathy; anti-HMGCR autoantibodies; immune-mediated necrotizing myopathy; immunosuppressives; inflammatory myopathy.

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Figures

Figure 1 and 2.
Figure 1 and 2.
MRI of right thigh axial T1 & T2 with fat suppression showing extensive edema of the right thigh musculature, suggestive of diffuse myositis.
See this image and copyright information in PMC

References

    1. Diamantis E, Troupis T, Mazarakis A, et al. Primary and secondary prevention of acute coronary syndromes: the role of the statins. Recent Adv Cardiovasc Drug Discov. 2015;9:97–105. ExternalResolverBasic [Context Link]. - PubMed
    1. Dalakas MC, Longo DL.. Inflammatory muscle diseases. N Engl J Med. 2015;372(18):1734–1747. View at Publisher View at Google Scholar View at Scopus. - PubMed
    1. Allenbach JK, Bouvier A-M.. High risk of cancer in autoimmune necrotizing myopathies: usefulness of myositis specific antibody. Brain A J Neurol. 2016;139(8):2131–2135. View at Publisher View at Google Scholar View at Scopus. - PubMed
    1. Mammen AL, Chung T, Christopher-Stine L, et al. Autoantibodies against 3-hydroxy-3- methylglutaryl-coenzyme A reductase in patients with statin-associated autoimmune myopathy. Arthritis Rheum. 2011;63:713–721. ExternalResolverBasic Bibliographic Links [Context Link]. - PMC - PubMed
    1. Mammen AL, Longo DL. Statin-associated autoimmune myopathy. N Engl J Med. 2016. February 18;374(7):664–669. 6p. - PubMed

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