Statin-induced necrotizing autoimmune myopathy: an extremely rare adverse effect from statin use
Statins are widely prescribed medications to prevent cardiovascular events. While self-limited statin myopathy is relatively common, statin-induced necrotizing autoimmune myopathy (SINAM) is extremely uncommon, with incidence of two cases per million per year. We present a case of SINAM after a deca...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Greater Baltimore Medical Center
2019-11-01
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| Series: | Journal of Community Hospital Internal Medicine Perspectives |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/20009666.2019.1702272 |
| _version_ | 1797969872026599424 |
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| author | Priyadarshani Sharma Bidhya Timilsina Janak Adhikari Prem Parajuli Rashmi Dhital Niranjan Tachamo |
| author_facet | Priyadarshani Sharma Bidhya Timilsina Janak Adhikari Prem Parajuli Rashmi Dhital Niranjan Tachamo |
| author_sort | Priyadarshani Sharma |
| collection | DOAJ |
| description | Statins are widely prescribed medications to prevent cardiovascular events. While self-limited statin myopathy is relatively common, statin-induced necrotizing autoimmune myopathy (SINAM) is extremely uncommon, with incidence of two cases per million per year. We present a case of SINAM after a decade of atorvastatin use, leading to debilitating weakness. A 71-year-old male presented with recurrent falls due to extreme bilateral lower-extremity weakness without pain or sensory changes. No fever, chills, rash, joint pain, recent infection or medication changes were reported. Reported taking atorvastatin 80 mg daily for 10 years. Physical examination revealed significant muscle wasting on right deltoid and proximal muscle weakness in all extremities. Lab tests included elevated creatinine kinase, aldolase, ESR, CRP and transaminases. Anti-HMGCR antibody was significantly elevated. TSH, serum protein electrophoresis and RPR were unremarkable. ANA, Anti-Jo-1, anti-Mi2, anti-SRP, anti-ds-DNA, anti-SSA and anti-SSB antibodies were negative. MRI of thigh revealed diffuse myositis. Electromyogram revealed an acute myopathic process. Muscle biopsy showed muscle necrosis and C5b-9 sarcolemmal deposits on non-necrotic fibers without rimmed vacuoles. He was diagnosed with SINAM. Statin was discontinued, and steroid, immunoglobulins and azathioprine were started with gradual improvement. Unlike the self-limiting statin myopathy, SINAM is more severe and is associated with significant proximal muscle weakness, markedly elevated CK and persistent symptoms despite statin discontinuation. Anti-HMGCR antibodies are present in 100% of cases. Immunosuppressants are the mainstay of treatment, and statin rechallenge should never be done in these cases. Although relatively rare, physicians should be cognizant of SINAM. |
| first_indexed | 2024-04-11T03:09:07Z |
| format | Article |
| id | doaj.art-1c93ff6ab1ab48df8a3223271d32f488 |
| institution | Directory Open Access Journal |
| issn | 2000-9666 |
| language | English |
| last_indexed | 2024-04-11T03:09:07Z |
| publishDate | 2019-11-01 |
| publisher | Greater Baltimore Medical Center |
| record_format | Article |
| series | Journal of Community Hospital Internal Medicine Perspectives |
| spelling | doaj.art-1c93ff6ab1ab48df8a3223271d32f4882023-01-02T12:14:39ZengGreater Baltimore Medical CenterJournal of Community Hospital Internal Medicine Perspectives2000-96662019-11-019650350610.1080/20009666.2019.17022721702272Statin-induced necrotizing autoimmune myopathy: an extremely rare adverse effect from statin usePriyadarshani Sharma0Bidhya Timilsina1Janak Adhikari2Prem Parajuli3Rashmi Dhital4Niranjan Tachamo5Reading Hospital, Tower Health System West ReadingReading Hospital, Tower Health System West ReadingSteward Carney HospitalReading Hospital, Tower Health System West ReadingReading Hospital, Tower Health System West ReadingReading Hospital, Tower Health System West ReadingStatins are widely prescribed medications to prevent cardiovascular events. While self-limited statin myopathy is relatively common, statin-induced necrotizing autoimmune myopathy (SINAM) is extremely uncommon, with incidence of two cases per million per year. We present a case of SINAM after a decade of atorvastatin use, leading to debilitating weakness. A 71-year-old male presented with recurrent falls due to extreme bilateral lower-extremity weakness without pain or sensory changes. No fever, chills, rash, joint pain, recent infection or medication changes were reported. Reported taking atorvastatin 80 mg daily for 10 years. Physical examination revealed significant muscle wasting on right deltoid and proximal muscle weakness in all extremities. Lab tests included elevated creatinine kinase, aldolase, ESR, CRP and transaminases. Anti-HMGCR antibody was significantly elevated. TSH, serum protein electrophoresis and RPR were unremarkable. ANA, Anti-Jo-1, anti-Mi2, anti-SRP, anti-ds-DNA, anti-SSA and anti-SSB antibodies were negative. MRI of thigh revealed diffuse myositis. Electromyogram revealed an acute myopathic process. Muscle biopsy showed muscle necrosis and C5b-9 sarcolemmal deposits on non-necrotic fibers without rimmed vacuoles. He was diagnosed with SINAM. Statin was discontinued, and steroid, immunoglobulins and azathioprine were started with gradual improvement. Unlike the self-limiting statin myopathy, SINAM is more severe and is associated with significant proximal muscle weakness, markedly elevated CK and persistent symptoms despite statin discontinuation. Anti-HMGCR antibodies are present in 100% of cases. Immunosuppressants are the mainstay of treatment, and statin rechallenge should never be done in these cases. Although relatively rare, physicians should be cognizant of SINAM.http://dx.doi.org/10.1080/20009666.2019.1702272statin-induced necrotizing autoimmune myopathyimmune-mediated necrotizing myopathyinflammatory myopathyanti-hmgcr autoantibodiesimmunosuppressives |
| spellingShingle | Priyadarshani Sharma Bidhya Timilsina Janak Adhikari Prem Parajuli Rashmi Dhital Niranjan Tachamo Statin-induced necrotizing autoimmune myopathy: an extremely rare adverse effect from statin use Journal of Community Hospital Internal Medicine Perspectives statin-induced necrotizing autoimmune myopathy immune-mediated necrotizing myopathy inflammatory myopathy anti-hmgcr autoantibodies immunosuppressives |
| title | Statin-induced necrotizing autoimmune myopathy: an extremely rare adverse effect from statin use |
| title_full | Statin-induced necrotizing autoimmune myopathy: an extremely rare adverse effect from statin use |
| title_fullStr | Statin-induced necrotizing autoimmune myopathy: an extremely rare adverse effect from statin use |
| title_full_unstemmed | Statin-induced necrotizing autoimmune myopathy: an extremely rare adverse effect from statin use |
| title_short | Statin-induced necrotizing autoimmune myopathy: an extremely rare adverse effect from statin use |
| title_sort | statin induced necrotizing autoimmune myopathy an extremely rare adverse effect from statin use |
| topic | statin-induced necrotizing autoimmune myopathy immune-mediated necrotizing myopathy inflammatory myopathy anti-hmgcr autoantibodies immunosuppressives |
| url | http://dx.doi.org/10.1080/20009666.2019.1702272 |
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