Statin-Induced Autoimmune Myopathy: A Diagnostic Challenge in Muscle Weakness.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Maryam Barkhordarian, Mark Grijalva, Albert Lee, Amer Jarri, Anna Belyayeva, Simcha Weissman
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Abstract

BACKGROUND Statin-induced myopathy can present with symptoms ranging from mild myalgia to significant muscle weakness. Muscle-related adverse effects of statins have been very challenging in clinical practice and they necessitate high clinical suspicion. This case report highlights how statin-induced autoimmune myopathy often goes undiagnosed. CASE REPORT We present a 69-year-old man with a past medical history of coronary artery disease who presented with myalgia and progressive proximal muscle weakness for 2 months, with a creatinine kinase of 8323 U/L. Atorvastatin was held on admission and the patient received intravenous (IV) fluid as treatment for presumed rhabdomyolysis. Although CK was trending down, he did not show significant improvement in muscle weakness or myalgia. At this point, myositis was suspected, so a myositis panel including anti-HMG Co-A reductase antibody was ordered and he was started on IV steroids. Anti-HMG Co-A reductase antibody was positive, and the rest of myopathy workup was negative. Meanwhile, the patient's muscle weakness significantly improved with IV steroid. He was discharged on methylprednisolone with close outpatient rheumatology follow-up. CONCLUSIONS Muscle-related adverse effects of statins, including rhabdomyolysis and myopathy, can fail to respond to conservative management. It is crucial to identify and manage statin-induced autoimmune myopathy as a possible differential diagnosis in patients with muscle weakness and elevated CK while on statin therapy who do not respond to intravenous fluid alone.

他汀类药物诱发的自身免疫性肌病:肌肉无力的诊断难题。
背景 他汀类药物诱发的肌病可表现为从轻微肌痛到明显肌无力的各种症状。他汀类药物与肌肉相关的不良反应在临床实践中极具挑战性,需要临床高度怀疑。本病例报告强调了他汀类药物诱发的自身免疫性肌病如何经常得不到诊断。病例报告 我们报告了一名既往有冠状动脉疾病病史的 69 岁男子,他出现肌痛和进行性近端肌无力 2 个月,肌酸激酶为 8323 U/L。入院时患者服用了阿托伐他汀,并接受了静脉输液,以治疗假定的横纹肌溶解症。虽然肌酸激酶呈下降趋势,但他的肌无力或肌痛症状没有明显改善。此时,医生怀疑患者患有肌炎,于是为他做了肌炎检查,包括抗-HMG Co-A 还原酶抗体,并开始静脉注射类固醇。抗-HMG Co-A 还原酶抗体呈阳性,而其他肌病检查结果均为阴性。同时,静脉注射类固醇后,患者的肌无力症状明显好转。他在风湿免疫科的密切门诊随访下,使用甲泼尼龙治疗后出院。结论 他汀类药物与肌肉相关的不良反应,包括横纹肌溶解症和肌病,可能对保守治疗无效。对于服用他汀类药物治疗期间出现肌无力和肌酸激酶(CK)升高,但仅靠静脉输液治疗无效的患者,将他汀类药物诱发的自身免疫性肌病作为可能的鉴别诊断进行识别和治疗至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
American Journal of Case Reports
American Journal of Case Reports Medicine-Medicine (all)
CiteScore
1.80
自引率
0.00%
发文量
599
期刊介绍: American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.
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