Atorvastatin hypersensitivity reaction within 24 hours of first dose

We report a case of atorvastatin-induced hypersensitivity reaction in a 58-year-old male following first exposure to the drug. The patient took one dose of atorvastatin 40 mg and presented to the emergency department (ED) within 24 h with a chief complaint of throat swelling, trouble swallowing, and throat pain. The patient did not have pruritis or skin manifestations. The patient's vital signs were within normal limits. However, the patient had leukocytosis with a white blood cell (WBC) count of 12.68 × 10³/mcL. Eosinophils were within normal limits at 1.6 × 10³/mcL. Bilirubin was slightly elevated at 1.6 mg/dL. The patient was treated with epinephrine, famotidine, and diphenhydramine, and his symptoms began to resolve within 15 min. Statin-induced hypersensitivity reactions could be explained by statins' effects on bradykinin 2 receptors that potentiate vasodilation and leading to angioedema. In the literature, cases of hypersensitivity associated with atorvastatin present after months of cumulative exposure. Therefore, this case is unique in that a reaction developed within 24 h of that first dose.