SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Statin Induced Autoimmune Necrotizing Myositis

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This case report describes a 71-year-old woman with coronary artery disease, hypertension, and hyperlipidemia who developed severe statin-induced autoimmune necrotizing myopathy after restarting atorvastatin. She had previously stopped high-dose atorvastatin because of myalgia. Following placement of a drug-eluting stent, she was prescribed low-dose atorvastatin 10 mg, but within three weeks she again developed generalized muscle pain that progressed to profound proximal weakness and inability to walk.<br /><br />Despite stopping atorvastatin, her symptoms worsened and creatine kinase (CK) levels remained markedly elevated, rising from 7,528 to 9,492. Aldolase was also high. Workup for other causes of myopathy, including hepatitis testing, thyroid studies, GGT, and myositis antibodies, was unrevealing. However, HMG-CoA reductase antibody testing was strongly positive at 314, supporting statin-associated autoimmune necrotizing myopathy. A thigh muscle biopsy confirmed necrotizing myopathy with type 2 muscle atrophy.<br /><br />The patient was advised to avoid statins and began aggressive physical therapy. Her CK levels gradually declined to 848, and she improved functionally from requiring a cane to walking with a walker.<br /><br />The report emphasizes that statin-induced myositis, although rare, can be severe and persistent even after the drug is discontinued. Patients with prior statin intolerance should be evaluated for anti-HMGCR antibodies rather than simply retried on lower doses or different statins. In patients who develop proximal muscle weakness while on statins, prompt CK testing and immediate discontinuation of the medication are essential to prevent serious complications.

Asset Subtitle

Benjamin Easow

Meta Tag

Author List Benjamin Easow, Darius Aliabadi, Paarmit Chhabra, Paramjit Kaur, Sindhu Yarrabelli, Syed Fatmi

Category Clinical Vignettes

Concept Statin-induced necrotizing autoimmune myopathy

Concept Statin-associated muscle adverse effect

Concept Proximal Muscle Weakness

Concept Creatine Kinase

Concept Statin Therapy

Distinguished Non-Finalist

Presenter Organization Southeasthealth

Presenting Author Benjamin Easow

Track Adult

Keywords

statin-induced autoimmune necrotizing myopathy

atorvastatin

HMG-CoA reductase antibody

proximal muscle weakness

creatine kinase

myalgia

muscle biopsy

coronary artery disease

hyperlipidemia

drug-eluting stent

Statin-induced necrotizing autoimmune myopathy

Statin-associated muscle adverse effect

Proximal Muscle Weakness

Creatine Kinase

Statin Therapy