An unusual case of familial hyperlipidemia with statin induced rhabdomyolysis

Abstract

Familial hypercholesterolemia (FH), also known as Type 2 familial dyslipidemia is a genetic disorder characterized by high levels of low-density lipoprotein (LDL) cholesterol in the blood. Elevated LDL cholesterol levels leads to ischemic heart disease in younger age group. FH is well known to cause deposition of cholesterol in muscle tendons causing tendon xanthomas which present as nodules over Achilles' tendon. Familial hypercholesterolemia is treated with high dose of statins to bring down the LDL cholesterol. We hereby report an unusual case of familial hypercholesterolemia with very high LDL levels (504 mg/dl) and tendon xanthomas who developed statin induced rhabdomyolysis due to consumption of high doses of statins. Patient had consumed both atorvastatin and rosuvastatin by mistake which led to rhabdomyolysis. A clinician must look out for this complication in any patient who is started on high dose of statins. Anticipation of this complication, patient education and periodic checking of muscle enzyme creatine phosphokinase (CPK) and serum creatinine in a patient on high dose statins helps in tackling this complication effectively.