Why the study?
Statin-induced immune-mediated necrotizing myopathy is a rare and challenging-to-diagnose inflammatory myopathy that persists after statin discontinuation.
Highlights a rare but severe complication of statin therapy (anti-HMGCR myopathy) that persists after statin discontinuation and requires aggressive immunosuppressive therapy for remission.
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Clinicians should consider anti-HMGCR myopathy in persistent statin myopathy; single case leaves optimal management open.
Statin-induced immune-mediated necrotizing myopathy, also known as anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) myopathy, is an inflammatory myopathy that is triggered by statin exposure and persists after statin discontinuation. It is a rare side effect of statins, distinct from the more commonly recognized statin-induced myalgia, that is challenging to diagnose and treat. We describe a case of anti-HMGCR myopathy in a 59-year-old male with a prior history of statin intolerance presenting with markedly elevated creatinine kinase, myoglobinuria, and one month of progressive proximal muscle weakness after restarting atorvastatin 10 months prior to admission. High-dose glucocorticoids led to rapid clinical improvement, although the patient relapsed upon tapering. Remission was attained at three months after combination therapy with azathioprine, intravenous immunoglobulin, and a prolonged prednisone taper.
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Stroie et al. (2020) studied this question.
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