[Pravastatin-induced dermatomyositis].
BACKGROUND
The toxic myopathy caused by statins (HMG-CoA reductase inhibitors) is well established. Recent reports add to these effects systemic immune diseases including systemic lupus erythematosus, vasculitis, polymyositis or dermatomyositis.


METHODS
We report a case of dermatomyositis in a 69-year-old patient treated with pravastatin [Elisor]. She presented with typical features of dermatomyositis 2 years after she started a treatment with pravastatin. The treatment was discontinued and she slowly improved, with a transient dermocorticosteroid treatment. Eight other patients with dermatomyositis and chronic treatment with HMG-CoA reductase inhibitors are reported in the literature. All of them presented with classical features of dermatomyositis. The discontinuation of the treatment was followed by spontaneous clinical and biological improvement in 3/9 patients. The other patients received high doses of corticosteroids and improved, except one patient who died of respiratory failure (pulmonary fibrosis) despite the adjunction of oral cyclophosphamide [Endoxan]. In these patients, dermatomyositis can be considered as a severe adverse reaction to HMG-CoA reductase inhibitors although a distinct casual link cannot be definitely established.


CONCLUSIONS
The increasing prescription of statins has led to the parallel increment of reported side-effects, where autoimmune diseases are now described. Among them, our case of dermatomyositis in a patient receiving pravastatin adds to the eight reported cases in the literature and highlights the potential role of statins as triggers of immune systemic diseases.
Zuech
P
P
Service de médecine interne, centre hospitalier intercommunal Poissy-Saint-Germain-en-Laye, 20, rue Armagis, 78100 Saint-Germain-en-Laye, France.
Pauwels
C
C
Duthoit
C
C
Méry
L
L
Somogyi
A
A
Louboutin
A
A
Veyssier-Belot
C
C
D000368:Aged; D000924:Anticholesteremic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D003882:Dermatomyositis / Q000139:chemically induced*; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy; D017035:Pravastatin / Q000009:adverse effects* / Q000627:therapeutic use*; D013997:Time Factors
D000924:Anticholesteremic Agents; D017035:Pravastatin