Statin-Induced Necrotizing Autoimmune Myositis: Diagnosis and Management

David Cha,Vaskar Mukerji,Basanti Mukerji,Fan Wang

doi:10.7759/cureus.13787

Statin-Induced Necrotizing Autoimmune Myositis: Diagnosis and Management

David Cha, Vaskar Mukerji + Show 2 more

Open Access

https://doi.org/10.7759/cureus.13787

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Abstract

Statins are among the most frequently prescribed drugs as they effectively lower cardiovascular mortality. Atherosclerotic plaques are stabilized and lipid levels are lowered, as statins inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. Patients placed on these drugs frequently report muscle aches, but true myositis that would call for discontinuance of the drug is actually uncommon. Workup for statin-induced myositis would require ruling out other causes of myositis and muscular dystrophies, and this can often be perplexing for the primary care physician to whom these patients initially present. This case report and recommendations may serve as a helpful guide.

Highlights

Myalgia is the most commonly reported adverse symptom when statins are prescribed [1,2,3,4]
Workup for statin-induced myositis would require ruling out other causes of myositis and muscular dystrophies, and this can often be perplexing for the primary care physician to whom these patients initially present
We present here a case of statin-induced necrotizing autoimmune myositis (NAM) and provide information on its diagnosis and management

Summary

Introduction

Myalgia is the most commonly reported adverse symptom when statins are prescribed [1,2,3,4]. An autoimmune myositis develops in patients on statins This is associated with the presence of IgG (immunoglobulin G) autoantibodies against 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, with muscle-cell necrosis on biopsy with regenerating cells [10]. A 57-year-old man with a past medical history of hyperlipidemia and hypertension presented with six months of progressive bilateral proximal arm and leg muscle weakness accompanied by fatigue He had been on atorvastatin 40 mg daily for three years prior to the onset of his symptoms, and it was stopped by his primary care physician (PCP). The patient came for serial clinic visits to measure muscle strength and CK level, which showed slow normalization through the few months. The patient’s CK had returned to normal at 43 and remained normal during subsequent visits

Discussion

Conclusions

Disclosures

Findings

Mammen AL

11. Mammen AL