SHM Converge Scientific Abstract ePoster Gallery-Statin Induced Autoimmune Necrotizing Myopathy Treated With Steroid and Azathioprine.

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A 70-year-old woman with diabetes, hyperlipidemia, hypothyroidism, and GERD presented with 2 weeks of progressive proximal muscle weakness, myalgia, difficulty dressing, and trouble climbing stairs. She had been taking atorvastatin for years, with the dose increased from 10 mg to 40 mg two years earlier. On exam, she had reduced strength in both upper and lower extremities. Labs showed marked rhabdomyolysis with CK 10,618 U/L, elevated troponin, and elevated AST/ALT, while EKG and chest X-ray were unremarkable. Atorvastatin was stopped and she was treated with IV fluids, but CK remained elevated, raising concern for autoimmune statin-induced myonecrosis.<br /><br />Further workup included myositis testing, HMGCR antibody, MRI of the thighs, and muscle biopsy. MRI showed nonspecific myositis in the pelvic and bilateral thigh muscles. HMGCR antibody returned strongly positive, and biopsy demonstrated necrotic myopathic changes. She was diagnosed with statin-induced autoimmune necrotizing myopathy (SIANM) and started on high-dose prednisone, with some improvement. However, she continued to have weakness and elevated CK after discharge, so azathioprine was added while prednisone was continued. Her symptoms improved significantly and CK normalized, allowing gradual steroid taper. She remains on azathioprine.<br /><br />The case highlights that SIANM is a severe statin-associated muscle disease in which weakness and CK elevation can persist or worsen even after statin discontinuation. Diagnosis is supported by elevated CK, anti-HMGCR antibodies, MRI, and muscle biopsy. Early recognition is important because treatment usually requires immunosuppression with corticosteroids and often additional agents such as azathioprine or IVIG.

Asset Subtitle

Prodip Paul

Meta Tag

Author List Julio Ramos, Koushik Paul, Mishouri Paul, Prodip Paul

Category Clinical Vignettes

Concept Statin-induced necrotizing autoimmune myopathy

Concept Proximal Muscle Weakness

Concept Creatine Kinase

Concept Anti-HMGCR Antibody

Concept High-Dose Corticosteroid

Distinguished Non-Finalist

Presenter Organization Geisinger Community Medical Center, Scranton, PA

Presenting Author Prodip Paul

Track Adult

Keywords

statin-induced autoimmune necrotizing myopathy

SIANM

atorvastatin

rhabdomyolysis

proximal muscle weakness

anti-HMGCR antibody

muscle biopsy

prednisone

azathioprine

elevated creatine kinase

Statin-induced necrotizing autoimmune myopathy

Proximal Muscle Weakness

Creatine Kinase

Anti-HMGCR Antibody

High-Dose Corticosteroid