SHM Converge Scientific Abstract ePoster Gallery-The Hidden Cost of Cholesterol Control: A Case of Statin Induced-Necrotizing Autoimmune Myopathy

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This case report describes statin-induced necrotizing autoimmune myopathy (SINAM), a rare but serious immune-mediated complication of statin therapy. A 51-year-old man with hyperlipidemia, hypertension, and diabetes developed more than a month of progressive proximal muscle weakness and dysphagia, even after stopping atorvastatin following a prior hospitalization for rhabdomyolysis and elevated liver enzymes.<br /><br />On admission, he had markedly elevated creatine kinase (CK >10,000 IU/L) and high AST/ALT levels. Initial workup for infectious, rheumatologic, and malignancy causes was negative, including ANA and myositis-related testing. Because CK remained persistently elevated despite supportive care and corticosteroids, rheumatology recommended muscle biopsy and intensified immunosuppression. Over the hospital course, he received high-dose prednisone, IV methylprednisolone, mycophenolate mofetil, and intravenous immunoglobulin (IVIG), with gradual clinical improvement and eventual decline in CK levels. Anti-HMG-CoA reductase antibody testing later confirmed SINAM, and muscle biopsy showed necrotizing myositis.<br /><br />The report highlights that SINAM can occur at any time during statin use and may continue after the drug is discontinued. Hallmark features include progressive proximal weakness, very high CK, and sometimes dysphagia or respiratory compromise. Diagnosis is supported by anti-HMG-CoA reductase antibodies and muscle biopsy showing muscle necrosis with minimal inflammation.<br /><br />Treatment typically requires stopping the statin and using immunosuppression, often with corticosteroids, IVIG, and steroid-sparing agents such as mycophenolate. The authors emphasize the importance of recognizing persistent weakness in statin users, since early diagnosis and treatment may prevent severe disability or life-threatening complications.

Asset Subtitle

Rogelio Pinon-Gutierrez

Meta Tag

Author List Haley Shah, Rogelio Pinon-Gutierrez

Category Clinical Vignettes

Concept Statin-induced necrotizing autoimmune myopathy

Concept Proximal Muscle Weakness

Concept Creatine Kinase

Concept Anti-HMGCR Antibody

Concept Corticosteroid

Distinguished Non-Finalist

Presenter Organization UC Davis

Presenting Author Rogelio Pinon-Gutierrez

Track Adult

Keywords

statin-induced necrotizing autoimmune myopathy

SINAM

atorvastatin

proximal muscle weakness

dysphagia

creatine kinase

anti-HMG-CoA reductase antibody

muscle biopsy

mycophenolate mofetil

intravenous immunoglobulin

Statin-induced necrotizing autoimmune myopathy

Proximal Muscle Weakness

Creatine Kinase

Anti-HMGCR Antibody

Corticosteroid