慢性抗HMG-CoA降解酶阳性死性肌肉炎与远程暴露于他类药物
Tooba Salar1, Massiel Jimenez1, Mazin Hameed1
1Department of Internal Medicine, Rochester Regional Health - Unity Hospital, Rochester, USA.
Cureus
|July 19, 2023
概括
由于抗HMGCR抗体,使用他类药物可能导致罕见的自身免疫性肌肉炎. 这种病例表明,在停止使用他类药物多年后,慢性死性肌肉炎的延迟诊断对免疫抑制剂有反应.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 类风湿病学 类风湿病学
背景情况:
- 类药物是广泛使用的降胆固醇药物.
- 肌肉相关的副作用,包括肌痛和狂肌痛,是已知的他类药物的不良影响.
- 一种罕见但严重的不良反应是他类药物诱导的抗-3-甲基-氨酸-协酶A减少酶 (anti-HMGCR) 死肌炎,由自身抗体介导.
研究的目的:
- 为了呈现一种慢性抗HMGCR死亡性肌肉炎的病例.
- 突出与延迟呈现和远程他类药物暴露相关的诊断挑战.
- 为了说明这种情况下的治疗反应.
主要方法:
- 一个76岁的男性病例报告显示,他患有渐进性的肌肉衰弱.
- 进行了临床检查,实验室测试 (肌酸激酶水平),磁共振成像 (MRI),自身免疫检查 (抗HMGCR抗体) 和肌肉活检.
- 治疗涉及口服普得尼松和甲铁酸盐.
主要成果:
- 患者表现出持续的肌肉衰弱和肌酸激酶水平升高,尽管之前停止了他类药物治疗.
- 核磁共振扫描显示了炎症性肌肉炎,自身免疫检查证实了抗HMGCR抗体的存在.
- 肌肉活检表明慢性活性肌肉炎与内膜炎症,纤维化和脂肪替代.
- 用普得尼松和甲状腺治疗导致症状改善和肌酸激酶水平的正常化.
结论:
- 类固醇诱导的抗HMGCR菌性肌炎可以慢性呈现,并且由于远程暴露史,可能难以诊断.
- 早期识别和免疫抑制疗法治疗对于管理这种罕见的自身免疫性疾病至关重要.
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