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September 5, 2026Journal of Medical Case ReportsOpen Access

Atorvastatin therapy is linked to immune-mediated necrotizing myopathy requiring statin withdrawal and rituximab.

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Population

A 63-year-old Chinese gentleman presenting with progressive proximal muscle weakness

Design

Case report

Key result

Atorvastatin therapy was associated with the development of immune-mediated necrotizing myopathy after 2.5 years, requiring statin withdrawal and immunosuppressive therapy with rituximab.

Authors

SXShaowei XuGYGard Ching Derek YingXCXiao Rui Catherine Chen

Discussion

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Overview

Supports recognition of late-onset statin-associated IMNM; leaves open questions on incidence and optimal immunosuppression.

Key Points

  • To describe the clinical presentation, diagnostic evaluation, and therapeutic response of statin-associated immune-mediated necrotizing myopathy.
  • Evaluated a 63-year-old male presenting with progressive proximal muscle weakness and elevated creatine kinase after 2.5 years of atorvastatin exposure.
  • Conducted diagnostic workup including muscle biopsy, anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase autoantibody testing, and immunosuppressive management.
  • Muscle biopsy and positive anti-HMGCR autoantibodies confirmed the diagnosis of immune-mediated necrotizing myopathy alongside markedly elevated creatine kinase levels.
  • Patient demonstrated clinical improvement following the initiation of immunosuppressive therapy.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P
Population
A 63-year-old man with type 2 diabetes who developed progressive proximal muscle weakness and markedly elevated creatine kinase levels after 2.5 years of atorvastatin therapy.
E
Exposure
Atorvastatin 20 mg daily for 2.5 years, followed by discontinuation and immunosuppressive therapy (prednisolone and rituximab).
O
Outcome
Diagnosis and treatment response of immune-mediated necrotizing myopathy (IMNM).safety

Statin-induced immune-mediated necrotizing myopathy is a rare but severe complication requiring prompt recognition, statin discontinuation, and immunosuppressive therapy.

Limitations

  • Single case report limits generalizability

Cite This Study

Xu et al. (2026) conducted a case report in Immune-mediated necrotizing myopathy (n=1). Atorvastatin was evaluated. Atorvastatin therapy was associated with the development of immune-mediated necrotizing myopathy after 2.5 years, requiring statin withdrawal and immunosuppressive therapy with rituximab.

synapsesocial.com/papers/6a9bd3c76b95aff0620eae1fhttps://doi.org/10.1186/s13256-026-06561-3
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Statin-Induced, Immune-Mediated Necrotizing Myopathy Triggered by Malignancy Successfully Treated with Immunosuppression2024 · 4 citations
  2. 2Statin-Associated Immune-Mediated Necrotizing Myopathy: An Underrecognised Cause of Progressive Muscle Weakness in Primary Care2026 · 1 citations
  3. 3Statin-Associated Immune-Mediated Necrotizing Myopathy: A Case Report2025
  4. 4Anti-HMG-CoA reductase myopathy, an undesirable evolution of statin induced myopathy: a case report2019 · 7 citations
  5. 5Statin-Induced Immune-Mediated Necrotizing Myopathy: An Increasingly Recognized Inflammatory Myopathy2020 · 15 citations