揭示了罕见的并发症:由他类药物诱导的免疫媒介性瘤性肌肉病变
Farheen Hussain Chowdhury1, Olena Mahneva2, Maniekha Maharaj1
1Department of Internal Medicine, Manatee Memorial Hospital, Bradenton, FL, USA.
The American journal of case reports
|December 13, 2023
概括
类他类药物诱导的死性自身免疫肌肉病是一种罕见的并发症. 这一案例凸显了在治疗他类药物期间肌肉衰弱的患者中识别抗HMG-CoA减少酶抗体的重要性.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 类他类药物诱导的化性自身免疫肌肉病变 (SINAM) 是一种罕见但严重的类他类药物治疗不良反应.
- 它的特点是近端肌肉软弱,疼痛和肌酸激酶 (CK) 水平升高.
- 病理生理学涉及到针对3 - 基-3 - 甲基氨酸-辅酶A减少酶 (HMG-CoA减少酶) 的自身抗体.
研究的目的:
- 在接受阿托瓦斯塔丁的患者中呈现SINAM病例.
- 强调这种罕见疾病的诊断标准和管理.
- 提醒临床医生,他类药物诱导肌肉病的可能性.
主要方法:
- 一个59岁的女性患有脱脂症,接受阿托瓦斯塔丁治疗的病例报告.
- 临床表现为严重的近端肌肉衰弱和升高的CK水平.
- 诊断工作包括CK测量,肌肉活检和抗HMG-CoA减少酶抗体的血清学分析.
主要成果:
- 患者呈现出严重的近端肌肉衰弱和CK水平高达12,000 IU/L的患者.
- 肌肉活检证实了肌纤维细胞缩.
- 血清学分析显示了抗HMG-CoA减少酶抗体,证实了免疫媒介性死肌病的诊断.
结论:
- 停止使用他类药物和使用皮质类固醇治疗至关重要.
- 在停用皮质类固醇后出现复发,需要重新开始治疗.
- 在使用他类药物时,临床医生必须考虑在患有不明原因肌肉虚弱的患者中使用SINAM.
相关概念视频
Myasthenia Gravis: Overview and Treatment
1.5K
Myasthenia gravis is a neuromuscular transmission disorder characterized by weakness and increased fatigability of skeletal muscles. It is an autoimmune disease affecting approximately one in 2000 people, where antibodies against the α1 subunit of nicotinic acetylcholine receptors are produced.
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
1.5K
Myasthenia Gravis: Diagnostic Tests
883
Myasthenia gravis is an autoimmune condition affecting neuromuscular transmission, causing generalized weakness in skeletal muscles. Initial diagnoses rely on patients' signs, symptoms, and medical history. The challenge lies in distinguishing myasthenia from other muscular dystrophies. An important diagnostic feature is the significant improvement of symptoms after administering anticholinesterase inhibitors.
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
883
Satellite Stem Cells and Muscular Dystrophy
2.0K
Satellite stem cells or myosatellite cells are quiescent stem cells that Alexander Mauro first identified in 1961. These cells are located between the sarcolemma, the plasma membrane of muscle fibers, and the basal lamina, the connective tissue sheath covering it. These mononucleated cells are activated in response to muscle injury, can transform into myoblasts, and may form or repair muscle fibers. Myosatellite cells can provide additional myonuclei for muscle regeneration or return to a...
2.0K
Skeletal Muscle Relaxants: Adverse Effects
375
Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
Unlike...
375
Disorders of the Skeletal Muscle
962
The clinical conditions affecting the skeletal muscle tissue are broadly categorized as musculoskeletal and neuromuscular disorders.
Musculoskeletal disorders
Musculoskeletal disorders involve injuries and conditions affecting the skeletal muscles and associated connective tissues. These disorders can arise from acute biomechanical stresses or chronic overuse and can occur across different age groups. Common injuries include sprains, fractures, and muscular strains, often resulting from...
Musculoskeletal disorders
Musculoskeletal disorders involve injuries and conditions affecting the skeletal muscles and associated connective tissues. These disorders can arise from acute biomechanical stresses or chronic overuse and can occur across different age groups. Common injuries include sprains, fractures, and muscular strains, often resulting from...
962
Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions
429
Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
Although all competitive neuromuscular blockers are designed...
429


