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Case Reports
. 2022 Jan 25;14(1):e21613.
doi: 10.7759/cureus.21613. eCollection 2022 Jan.

A Case Series of Statin-Induced Necrotizing Autoimmune Myopathy

Alisha Sharma  1 , Clio Musurakis  2 , Nur Un Nisa Nabil  3 , Bidhya Poudel  1 , Angkawipa Trongtorsak  1
Affiliations
Case Reports

A Case Series of Statin-Induced Necrotizing Autoimmune Myopathy

Alisha Sharma et al. Cureus. .

Abstract

The use of statins has been increasing over the past decade for the primary and secondary prevention of cardiovascular disease worldwide. Subsequently, various side effects have also been unfolding. Muscle-related side effects secondary to statins range from myalgia to rhabdomyolysis and need close monitoring for early detection. Statin-induced necrotizing autoimmune myopathy (SINAM) in particular is unique given its pathophysiology, trigger factor, genetic predisposition, and aggressive management strategy. We present two cases of SINAM and discuss the clinical aspects of diagnosis, investigation, and management. Statin-induced necrotizing autoimmune myopathy usually presents with proximal myopathy along with increased creatinine kinase (CK) levels which do not resolve with only statin discontinuation. Diagnosis should be made with biopsy and 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibody detection. The investigation should also be directed to rule out other etiology of proximal myopathy. In most cases, rechallenge with a statin is unsuccessful and immunosuppressive treatment is essential.

Keywords: idiopathic rhabdomyolysis; proximal weakness; sinam; statin; statin-induced myopathy; statin-induced necrotizing autoimmune myopathy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CK level trend since admission to discharge
CK: Creatine kinase
Figure 2
Figure 2. H&E staining showing variation in muscle fibre size with scattered necrotic and regenerating muscle fibres
H&E staining: Hematoxylin and eosin stain
Figure 3
Figure 3. Patchy sarcolemmal/sarcoplasmic MHC class 1 expression
MHC: Major histocompatibility
Figure 4
Figure 4. Trichrome staining showing necrotic muscle fibres which are seen with a darker staining pattern
Figure 5
Figure 5. CK level trend since admission to discharge
CK: Creatinine kinase
Figure 6
Figure 6. H&E stain showing a few necrotic muscle fibres
H&E staining: Hematoxylin and eosin stain
Figure 7
Figure 7. Sarcolemmal/sarcoplasmic MHC class I expression
MHC: Major histocompatibility
See this image and copyright information in PMC

References

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