Statin-related immune-mediated necrotizing myopathy: a case report

While the safety profile of statins is generally considered as robust, they are known to be associated with a spectrum of muscle-related adverse effects, most of which are mild and reversible upon discontinuation of statins with some rare but serious exceptions. A 63-year-old Chinese gentleman presented with progressive proximal muscle weakness and markedly elevated creatine kinase levels after 2.5 years of atorvastatin therapy. The diagnosis of immune-mediated necrotizing myopathy (IMNM) was ascertained with muscle biopsy and positive autoantibody of anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase, and his condition responded to immunosuppressive therapy. IMNM is a rare but serious side effect related with statin use with delayed onset. With potential possibility of permanent disability, it is an important side effect that requires primary care doctors to maintain a high level of vigilance. The prompt recognition and immunosuppressive therapy is the key to avoid serious consequences.