ArticleFederal practitioner : for the health care professionals of the VA, DoD, and PHS2025
Statin-Induced Necrotizing Autoimmune Myopathy in a Patient With Complex Diabetes Management.
Article in Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: In rare cases, statin therapy for the reduction of lipid levels may cause muscle-related adverse effects leading to autoimmune myopathy. Statin-induced necrotizing autoimmune myopathy (SINAM) is typically accompanied by symmetrical proximal muscle weakness and elevated creatine phosphokinase (CPK). Glucocorticoids are the first-line treatment, but therapy may escalate to include methotrexate and/or intravenous immune globulin therapy (IVIG). Case Presentation: A male aged 59 years with confirmed atorvastatin adherence for 1 year presented with a 4-month history of fatigue, neuropathy, and progressive proximal muscle weakness. Laboratory tests revealed elevated CPK as high as 12,990 mcg/L. The anti-3-hydroxy-3-methlyglutaryl coenzyme A reductase (anti-HMGCR) antibody test was positive, and the patient started immunosuppressive therapy with IVIG therapy monotherapy (2 g/kg) over 3 days. Gluocorticoid therapy was not used due to difficult to control type 2 diabetes. After hospital discharge, the patient continued monthly IVIG treatment. Following 7 total rounds (6 rounds postadmission) of IVIG, the patient reported an improvement in activity, increased strength in his daily activities, and his CPK level continued decreasing to 680 mcg/L. Conclusions: Patients presenting with proximal muscle weakness and elevated CPK, even after statin discontinuation, should be considered for a full workup for potential SINAM. The detection of anti-HMGCR antibodies or presence of necrosis on muscle biopsy are necessary for a formal diagnosis. This case displayed success with IVIG monotherapy, although previous research suggests the best chance of muscle symptom improvement is with a combination of a glucocorticoid, methotrexate, and IVIG.
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