Statin-associated rhabdomyolysis triggered by grapefruit consumption

A 40-year-old woman was admitted to the emergency room for bilateral lower extremity weakness. She had been exercising regularly in a gym, including workout and aerobics, and skydived regularly. She had felt perfectly healthy until 10 days earlier when she noticed slight muscle weakness and myalgia that increased gradually. Examination revealed bilateral proximal leg weakness, although muscle strength in the face, neck, arms, and distal legs was normal. Walking distance was <20 meters. Initial laboratory studies revealed dramatically increased serum levels of creatine kinase (12,640 U/L), myoglobin (6,453 μg/L), aspartate aminotransferase (623 U/L), and alanine aminotransferase (700 U/L), suggesting rhabdomyolysis. Serum electrolytes and renal function were normal. The patient was taking simvastatin (80 mg/d taken at bedtime) for hypercholesterolemia related to a heterozygous familial defective apolipoprotein B100 mutation. Statin-associated rhabdomyolysis was assumed, and simvastatin was discontinued. …