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Statin-induced myopathy: a case report
Emmanuel De Cock1, Heidi Hannon2, Veronique Moerman3
1Cardiology Resident, Ghent University Hospital, Department of Cardiology, Corneel Heymanslaan 10, Ghent, Belgium.
European Heart Journal. Case Reports
|April 26, 2019
Summary
Statin-induced immune-mediated necrotizing myopathy (IMNM) requires aggressive immunosuppression, unlike common benign muscle pain. Early diagnosis through antibody testing and biopsy is crucial for effective treatment.
Area of Science:
- Cardiovascular Pharmacology
- Neuromuscular Disorders
- Immunology
Background:
- Statins are widely prescribed for cardiovascular disease, but muscle pain is a common side effect.
- Differentiating benign muscle pain from serious myopathies like immune-mediated necrotizing myopathy (IMNM) is clinically significant.
Observation:
- A 68-year-old woman developed proximal muscle weakness and elevated creatine kinase (CK) after starting atorvastatin.
- Despite statin discontinuation and rhabdomyolysis treatment, her CK levels remained high, and muscle biopsy revealed inflammatory changes.
Findings:
- The patient was diagnosed with IMNM induced by statins, confirmed by high anti-HMG-CoA reductase antibody titers.
- Treatment with corticosteroids and methotrexate led to gradual improvement in muscle strength, pain, and CK levels.
Implications:
- Statin-induced IMNM is a distinct, serious adverse effect requiring prompt recognition and management.
- Testing for anti-HMGCR antibodies and considering muscle biopsy are vital for patients with persistent muscle weakness and elevated CK on statins.
- Aggressive immunosuppressive therapy, alongside statin cessation, is mandatory for treating statin-induced IMNM.
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