Atorvastatin
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Autoimmune necrotising myopathy: case report A 77-year-old man developed autoimmune necrotising myopathy during treatment with atorvastatin for hypercholesterolaemia. The man was admitted with generalised pain. An anamnesis showed that he had been receiving atorvastatin [route and dosage not stated] for hypercholesterolaemia from 3 years with concurrent administration of other medications. Physical examination showed thigh muscle contractions, tetrahyperreflexia and myoclonus along with preserved motor strength. Speech therapist suggested nil per os because of dysphagia, and a nasogastric tube was swiftly placed. Laboratory findings demonstrated creatinine kinase (CK) level of 6000 U/l. Infectious and immune disease panels were negative. To exclude serotonin syndrome, the man’s tramadol and venlafaxine were discontinued with no improvement. Myocardial infarction was excluded. A MRI with short-TI inversion recovery sequences of the thigh muscles revealed oedema consistent with myositis. A thoracoabdominopelvic CT scan revealed no neoplastic process. Hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibody titre was increased to 200. Despite treatment with immunoglobulin and methylprednisolone from day 16, he died 20 days after admission due to pneumonia. Post-mortem histology of the lower limb and pharyngeal muscles showed severe necrotising myopathy. A necrotic muscle fibres with C5b-9 immunostaining, macrophagic infiltration with CD68 immunostaining with few lymphocytes along with myophagia. On comparison with the thigh muscles, the significant damage to the pharyngeal muscles was noted. Bilateral foci of bronchopneumonia and chronic bronchoaspiration signs confirmed the diagnosis of aspiration pneumonia. Based on these findings, atorvastatin-induced autoimmune necrotising myopathy was confirmed. Mirlesse N, et al. Statin-induced autoimmune necrotizing myopathy with pharyngeal muscles involvement. Age and Ageing 49: 883-884, No. 5, Sep 2020. Available from: URL: http://doi.org/10.1093/ageing/afaa038 803518031
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Reactions 28 Nov 2020 No. 1832
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