Statin Induced Autoimmune Necrotizing Myopathy (SIANM): An Alarming Adverse Event of a Familiar Medication

Nagapratap Ganta,Viraj Shah,Pramil Cheriyath,Dina Alnabwani,Sharon Hechter,Veera Jayasree L Bommu

doi:10.7759/cureus.22273

Abstract

Statins are a widely prescribed medication that lowers serum cholesterol by inhibiting the HMG-CoA reductase enzyme, a rate-limiting step in cholesterol synthesis. Myopathy is one of the well-known adverse effects of statins, mainly when prescribed with the fibrates. However, statin-induced autoimmune necrotizing myopathy (SIANM) is an infrequent and severe complication. Hence, all clinicians should be more vigilant regarding this complication and treat it early to prevent acute kidney injury (AKI).

Highlights

Statins are a class of drugs commonly used to prevent cardiovascular events by lowering serum total cholesterol and triglyceride levels [1]
We report a rare case of statin-induced autoimmune necrotizing myopathy in a 67-year-old male patient
The incidence of adverse effects with lovastatin, simvastatin, or atorvastatin was higher (4.2 per 100,000 person-years) as they are oxidized by cytochrome P450 3A4 (CYP3A4, which is blocked by several medicines) than pravastatin or fluvastatin [2]

Summary

Introduction

Statins are a class of drugs commonly used to prevent cardiovascular events by lowering serum total cholesterol and triglyceride levels [1]. We report a rare case of statin-induced autoimmune necrotizing myopathy in a 67-year-old male patient. A 67-year-old male with a past medical history of hypercholesterolemia, type II diabetes mellitus, hypertension, and liver disease presented to the emergency department (ED) for outpatient lab abnormalities concerning transaminitis (aspartate aminotransferase (AST)/ alanine aminotransferase (ALT) of 274/198) He reported severe proximal weakness in his thighs and shoulders that started insidiously and progressively became worse over several months. Due to the patient not having any physical markers of a traumatic injury or fall with a long time on the ground, his statin medication was empirically discontinued because it may be statin-induced myopathy The patient will be monitored on a long-term basis to comment on the effectiveness of the current treatment plan

Discussion

Conclusions

Disclosures

Findings

Mammen AL