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Various toxicites: case report A 56-year-old woman developed ischaemic hepatitis and hepatic steatosis during treatment with atorvastatin and simvastatin for heart failure. Additionally, she developed rhabdomyolysis secondary to pharmacokinetic interaction between simvastatin and atorvastatin. She also developed Clostridium difficile infection following administration of broad spectrum antibacterials including ceftriaxone, ciprofloxacin, meropenem, metronidazole, oxacillin, piperacillin, tazobactam and vancomycin [routes not stated; not all dosages stated]. The woman had arterial hypertension and started exepriencing dyspnoea on major exertion for a year and a half prior to hospitalisation. In September 2016 (at the age of 55 years), she was admitted to a hospital and diagnosed with acute myocardial infarction and mitral valve disease. After hospital discharge, she showed a functional class IV (New York Heart Association) dyspnoea, orthopnea and sporadic episodes of paroxysmal nocturnal dyspnoea, indicating heart failure. She was being treated with simvastatin 40mg, once a day along with various concomitant medications. On further examination, the mitral valve demonstrated partially ruptured chordae tendineae. Furthermore, she showed marked cardiomegaly and signs of pulmonary congestions. A surgical procedure to correct valve regurgitation ancoronary artery bypass grafting (CABG) surgery was indicated. On 8 February 2017, she underwent cardiac catheterisation, and received atorvastatin. At the same time, she showed progressing diffuse myalgia and functional class worsening with dyspnoea at rest and orthopnoea up to 3 days prior to hospitalisation, associated with reduced urinary output and darkened urine. She showed chest pain in the inframammary region along with irradiation to the epigastric region, with worsening at usual efforts, poorly characterised, lasting for hours without improvement factors. She was constipated for 3 days. On physical examination, she was in a regular general condition, +/4+ icteric skin, 2+/4+ skin pallor, hydrated, acyanotic and afebrile. Her heart rate was 65 bpm, BP was 70/50mm Hg, oxygen saturation was 90%, with fine crackles in lung bases; auscultation disclosed rhythmic heart sounds, and 3+/6+ regurgitation holosystolic murmur in mitral focus. Her abdomen was flat and intestinal sounds noises were present, with a palpable liver at 2cm from the right costal margin. A diagnoses of rhabdomyolysis, acute renal failure, ischaemic hepatitis and possible infective endocarditis were considered. The woman received treatment with norepinephrine, furosemide, ceftriaxone and oxacillin. On 23 February 2017, she underwent various investigations. Blood culture showed a positive result for Staphylococcus hominis, sensitive to oxacillin and the urine culture was positive for multisensitive Escherichia coli. The antibiotics were then changed to vancomycin, piperacillin and tazobactam on 3 March 2017. In addition to vasoactive drugs, she underwent haemodialysis. On the same day, she underwent c