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Statin-Induced Necrotizing Autoimmune Myopathy: Diagnosis and Treatment Approach
Varshini Srinivasan1, Samyuktha Prabu1, Jad G Sfeir1,2
1Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA.
JCEM Case Reports
|December 11, 2024
Summary
Statin use can rarely cause immune-mediated necrotizing myopathy (IMNM), an autoimmune condition. Early diagnosis and treatment with immunosuppressants can improve outcomes for this rare side effect.
Area of Science:
- Neurology
- Immunology
- Pharmacology
Background:
- Statins are widely used for cardiovascular disease prevention.
- Immune-mediated necrotizing myopathy (IMNM) is a recognized, albeit rare, adverse effect of statin therapy.
- Anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibodies are associated with IMNM.
Observation:
- A 64-year-old male with hyperlipidemia developed progressive proximal muscle weakness and pain.
- The patient had a history of atorvastatin and rosuvastatin use.
- Elevated creatinine kinase (CK) levels (13,921 IU/L) and positive anti-HMGCR antibodies (>200 CU) were detected.
Findings:
- Electromyography and muscle biopsy confirmed myonecrosis.
- The patient's condition improved with prednisone and intravenous immunoglobulin (IVIG) therapy, indicated by a decline in CK levels.
- This case highlights statin-induced necrotizing autoimmune myopathy (SINAM).
Implications:
- Physicians should consider IMNM in patients with unexplained muscle weakness and elevated CK levels, especially those on statins.
- Prompt diagnosis involving antibody testing and discontinuation of the offending statin is crucial.
- Early immunosuppressive treatment can lead to favorable clinical outcomes and prevent further muscle damage.
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