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Case Reports
. 2023 Sep 25;2023(9):omad097.
doi: 10.1093/omcr/omad097. eCollection 2023 Sep.

A case of anti-HMGCR myopathy in a patient with breast cancer and anti-Th/To antibodies

Mohammad Yassine Chérif  1 , Ioannis Raftakis  1 , Marjolaine Weynand  1 , Elena Dragan  1 , Carole Nagant  2 , Sophie Lecomte  3 , Valérie Badot  1
Affiliations
Case Reports

A case of anti-HMGCR myopathy in a patient with breast cancer and anti-Th/To antibodies

Mohammad Yassine Chérif et al. Oxf Med Case Reports. .

Abstract

Statins competitively inhibit the activity of HMGCR (3-hydroxy-3-methylglutaryl coenzyme A reductase), which is a key enzyme in cholesterol synthesis. These are effective drugs for the management of cardiovascular disease and are generally well tolerated but several side effects have been reported. Muscular adverse symptoms are various and, rarely, statin exposure may lead to authentic immune-mediated necrotizing myopathy (IMNM), namely anti-HMGCR myopathy. However, cases of IMNM associated with cancer have been described. We discuss herein a case of IMNM in a patient with breast cancer previously exposed to statins and with the presence of anti-Th/To antibodies without clinical correlation.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
CK kinetics in relation to treatment.
Figure 2
Figure 2
Right quadriceps femoris muscle histology. Frozen sections of the quadriceps muscle biopsy. In addition to moderate variation in fiber size, necrotic fibers are seen and highlighted with acid phosphatase stain. Those fibers are surrounded by macrophages. No lymphocytic infiltrate was observed. (a) Harris HE stain (×200); (b) Modified Gomori trichrome stain (×200); (c) Acid phosphatase stain (×200).
Figure 3
Figure 3
Coronal view of PET-CT. Coronal view of PET-CT showing diffuse muscular hypermetabolism of the striated skeletal musculature, in particular in the trapezius and left upper limb.
See this image and copyright information in PMC

References

    1. Kurashige T. Anti-HMGCR myopathy: clinical and histopathological features, and prognosis. Curr Opin Rheumatol 2021;33:554–62. - PubMed
    1. Allenbach Y, Mammen AL, Benveniste O, Stenzel W, Immune-Mediated Necrotizing Myopathies Working Group . 224th ENMC International Workshop: clinico-sero-pathological classification of immune-mediated necrotizing myopathies Zandvoort, The Netherlands, 14–16 October 2016. Neuromuscul Disord 2018;28:87–99. - PubMed
    1. Needham M, Fabian V, Knezevic W, Panegyres P, Zilko P, Mastaglia FL. Progressive myopathy with upregulation of MHC-I associated with statin therapy. Neuromuscul Disord 2007;17:194–200. - PubMed
    1. Parker BA, Capizzi JA, Grimaldi AS, Clarkson PM, Cole SM, Keadle J et al. Effect of statins on skeletal muscle function. Circulation 2013;127:96–103. - PMC - PubMed
    1. Ge Y, Lu X, Peng Q, Shu X, Wang G. Clinical characteristics of anti-3-hydroxy-3-methylglutaryl coenzyme A reductase antibodies in Chinese patients with idiopathic inflammatory myopathies. PLoS One 2015;10:e0141616. - PMC - PubMed

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