Statin-Induced Autoimmune Necrotizing Myositis: A Case Report

Abstract

Statin therapy is considered one of the main therapies indicated to reduce the risk of cardiovascular death in patients with atherosclerotic cardiovascular disease. Maximal risk reduction is linked to the degree of reduction of the low-density lipoprotein cholesterol; therefore, high-intensity dosing is required with coronary artery disease. Musculoskeletal side effects are reported with the use of statin, especially at high doses. Although myopathy is a common side effect, autoimmune-mediated necrotizing myositis is a rare side effect usually related to the development of hydroxymethylglutaryl-coenzyme A reductase antibodies which attack the muscles leading to swelling manifesting as muscle weakness and pain, as presented in our case report.

Statin-Associated Myalgia, Myopathy, and Myositis

“…The MRI of affected limbs typically shows symmetrical and diffuse intramuscular and intrafascial edema whereas the necrotizing form is characterized by more widespread muscle involvement and signs of fibroadipose substitution. 31 Muscle biopsy of an affected limb may be used to assess the muscle fibers and measure muscle enzymes, although other less invasive diagnostic tests such as MRI are recommended. 25 In patients positive for immune-mediated necrotizing myopathy, muscle biopsy shows necrosis with regeneration of muscle fibers and minor inflammation composed mainly of macrophages.…”

“…MRI with short tau inversion recovery sequences can be used to detect inflammatory changes. The MRI of affected limbs typically shows symmetrical and diffuse intramuscular and intrafascial edema whereas the necrotizing form is characterized by more widespread muscle involvement and signs of fibroadipose substitution 31. Muscle biopsy of an affected limb may be used to assess the muscle fibers and measure muscle enzymes, although other less invasive diagnostic tests such as MRI are recommended 25.…”

Statin-Associated Myalgia, Myopathy, and Myositis

“…The MRI of affected limbs typically shows symmetrical and diffuse intramuscular and intrafascial edema whereas the necrotizing form is characterized by more widespread muscle involvement and signs of fibroadipose substitution. 31 Muscle biopsy of an affected limb may be used to assess the muscle fibers and measure muscle enzymes, although other less invasive diagnostic tests such as MRI are recommended. 25 In patients positive for immune-mediated necrotizing myopathy, muscle biopsy shows necrosis with regeneration of muscle fibers and minor inflammation composed mainly of macrophages.…”