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A Rare Cause of Transaminitis: Anti-3-Hydroxy-3-Methylglutaryl-CoA Reductase Myopathy
Ross M Dies1, Peng-Sheng Ting2, Munraj Singh1
1Department of Medicine, Gastroenterology Section, Louisiana State University Health Sciences Center, New Orleans, USA.
Abstract:
Persistent transaminitis has a very broad differential diagnosis, and extrahepatic causes may often be initially overlooked. Anti-3-hydroxy-3-methylglutaryl-CoA reductase (anti-HMGCR) myopathy is a subtype of immune-mediated necrotizing myopathy (IMNM) characterized by the presence of anti-HMGCR antibodies and myofiber injury. Patients typically present with proximal extremity weakness, transaminitis, and a history of statin use. Unlike statin intolerance or statin myopathy, the weakness and biochemical abnormalities persist despite discontinuation of the drug. Here, we present a case of a patient with transaminitis and elevated creatine kinase (CK) levels, which persisted after cessation of his statin and were found to be associated with mildly elevated anti-HMGCR antibodies. Interestingly, he did not require immunosuppression for the resolution of his myopathy.
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