Although 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors are well tolerated, a small subset of patients may develop autoimmune myopathy, classified as immune-mediated necrotizing myopathy. Statin-induced immune-mediated necrotizing myopathy can present as proximal muscle weakness and in some cases as dysphagia and respiratory distress. We present two cases of patients taking statins who developed dysphagia and muscle weakness found to have statin-induced immune-mediated necrotizing myopathy. Both patients were treated with immunosuppressive therapy: one did well clinically, while the other had an aggressive form of statin-induced immune-mediated necrotizing myopathy and succumbed to the disease. Although statin-induced immune-mediated necrotizing myopathy is rare, early treatment to induce remission of this disabling condition should be initiated to prevent morbidity and mortality.

Hepatocellular carcinoma (HCC) comprises most primary liver cancer cases (75%-85%) and has a poor prognosis with a median survival of 9-20 months. 1,2 Metastatic HCC sites usually involve lungs, lymph nodes, and bones. Approximately 0.5%-3.5% of HCC metastases occur to the skin. 3 Prompt diagnosis can reduce the mortality rate of HCC by providing early curative treatment options or systemic therapy once metastasized.

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