Statin-induced autoimmune necrotizing myopathy with pharyngeal muscles involvement

Mirlesse, Nicolas; Égervári, Kristóf; Bornand, Aurélie; Lecluse, Julien; Lobrinus, Johannes Alexander; Scheffler, Max; Serratrice, J.; Prendki, Virginie; Cuvelier, Clémence

doi:10.1093/ageing/afaa038

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…Proximal upper limb-only weakness can be confused with shoulder girdle myopathy. Manifestation with dysphagia has also been reported [ 16 ]. If untreated, the symptoms become more severe with resultant muscle loss and weakness.…”

Section: Discussionmentioning

confidence: 99%

Refractory Statin-Induced Immune-Mediated Necrotizing Myositis: Challenges and Perils in Its Management

Yeo¹,

Yaakub²,

Wang³

et al. 2022

Cureus

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Statin or 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) inhibitor is widely used and plays a vital role in the management of cardiovascular and cerebrovascular diseases. Statin is generally safe and its side effects are mostly mild and self-limiting. Immune-mediated necrotizing myositis (IMNM) is a rare and serious side effect characterized by the presence of anti-HMGCR inhibitor and myositis. Long-term immunosuppressive therapy is often required to manage it, and in refractory cases, the treatment can be very challenging. We report the case of a 55-year-old female with underlying diabetes mellitus and hyperlipidemia who developed refractory statin-induced IMNM despite being administered prednisolone, methotrexate, azathioprine, and immunoglobulin. After the introduction of rituximab, steroids were able to be tapered down to the lowest maintenance dose. Unfortunately, the patient subsequently succumbed to severe coronary artery disease (CAD) likely caused by the long-term steroid therapy, highlighting the difficulty and complications associated with the treatment of IMNM, especially in patients with cardiovascular risk factors.

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Section: Discussionmentioning

confidence: 99%

Refractory Statin-Induced Immune-Mediated Necrotizing Myositis: Challenges and Perils in Its Management

Yeo¹,

Yaakub²,

Wang³

et al. 2022

Cureus

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“…Часто (до 25% случаев) отмечается дисфагия, которая повышает риск развития аспирационной пневмонии. Слабость дыхательной мускулатуры и в редких случаях мышц гортани может привести к нарушению функции дыхания и даже потребовать искусственной вентиляции легких [13]. Лицевая мускулатура затрагивается редко.…”

Section: клиническая картинаunclassified

Diagnosis and treatment of statin-induced necrotizing autoimmune myopathy

Sumarokov¹,

Ezhov²

2022

CPT

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Statin-induced necrotizing autoimmune myopathy (SINAM) is an exceptionally rare complication of statin therapy. SINAM belongs to the group of idiopathic inflammatory myopathies and is characterized by muscle cell necrosis and regeneration leading to muscle atrophy. Prominent lymphocytic infiltrates in muscle tissue are absent. Progressive muscle weakness in upper and lower extremities is the main clinical manifestation of SINAM. Autoimmune mechanism of pathogenesis explain the absense of therapeutic effect of statin discontinuation and the risk of relapses. Diagnosis of SINAM can be established by clinical and serologic data, muscle biopsy and the results on noninvasive methods (MRI, ultrasound). Early initiation of immunosuppressive treatment is essential to achieve the cure of SINAM.

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“…Statin-associated necrotizing myopathy (SANM), characterized by symmetrical weakness and muscle enzyme elevations as a consequence of necrosis and regeneration of myofibers, is a rare disease that occurs in patients treated with statins [1][2][3]. Previous studies suggested that statins enhance the expression of 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR), the enzymatic target of statins, in genetically susceptible patients, leading to the development of disease-specific antibodies against HMGCR [4][5][6][7][8][9]. SANM causes life-threatening hypoventilationmediated hypoxemia and hypercapnia, but therapeutic strategies for SANM have not been established yet.…”

Section: Introductionmentioning

confidence: 99%

Recovery from hypoxemia and Hypercapnia following noninvasive pressure support ventilation in a patient with statin-associated necrotizing myopathy: a case report

et al. 2020

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Background: Statin-associated necrotizing myopathy (SANM) is a rare autoimmune disorder caused by administration of statins. SANM is characterized by weakness due to necrosis and regeneration of myofibers. Here we report the first case of SANM with acute respiratory failure treated with noninvasive pressure support ventilation in addition to immunosuppressants. Case presentation: A 59-year-old woman who had been treated with 2.5 mg/day of rosuvastatin calcium for 5 years stopped taking the drug 4 months before admission to our hospital due to elevation of creatine kinase (CK). Withdrawal of rosuvastatin for 1 month did not decrease the level of CK, and she was admitted to our hospital due to the development of muscle weakness of her neck and bilateral upper extremities. Anti-3-hydroxy-3-methylglutaryl coenzyme A reductase antibodies were positive. Magnetic resonance imaging showed myositis, and muscle biopsy from the right biceps brachii muscle showed muscle fiber necrosis and regeneration without inflammatory cell infiltration, suggesting SANM. After the diagnosis, she received methylprednisolone pulse therapy (mPSL, 1 g/day × 3 days, twice) and subsequent oral prednisolone therapy (PSL, 30 mg/day for 1 month, 25 mg/day for 1 month and 22.5 mg/day for 1 month), leading to improvement of her muscle weakness. One month after the PSL tapering to 20 mg/day, her muscle weakness deteriorated with oxygen desaturation (SpO2: 93% at room air) due to hypoventilation caused by weakness of respiratory muscles. BIPAP was used for the management of acute respiratory failure in combination with IVIG (20 g/day × 5 days) followed by mPSL pulse therapy (1 g/day × 3 days), oral PSL (30 mg/day × 3 weeks, then tapered to 25 mg/day) and tacrolimus (3 mg/day). Twenty-seven days after the start of BIPAP, she was weaned from BIPAP with improvement of muscle weakness, hypoxemia and hypercapnia. After she achieved remission with improvement of muscle weakness and reduction of serum CK level to a normal level, the dose of oral prednisolone was gradually tapered to 12.5 mg/day without relapse for 3 months.

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Statin-induced autoimmune necrotizing myopathy with pharyngeal muscles involvement

Cited by 5 publications

References 5 publications

Refractory Statin-Induced Immune-Mediated Necrotizing Myositis: Challenges and Perils in Its Management

Refractory Statin-Induced Immune-Mediated Necrotizing Myositis: Challenges and Perils in Its Management

Diagnosis and treatment of statin-induced necrotizing autoimmune myopathy

Recovery from hypoxemia and Hypercapnia following noninvasive pressure support ventilation in a patient with statin-associated necrotizing myopathy: a case report

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