title: Severe statin-induced rhabdomyolysis mimicking Guillain-Barré syndrome in four patients with diabetes mellitus treated with fusidic acid.
abstract: BACKGROUND
  An interaction between fusidic acid and HMG coenzyme A reductase inhibitors (statins), resulting in rhabdomyolysis, has been described. Pain and mild weakness are common presenting symptoms.
  
  
  METHODS
  We report four patients with Type 2 diabetes prescribed long-term statin treatment who, following treatment with fusidic acid, presented atypically with painless, severe flaccid paralysis suggestive of Guillain-Barré syndrome. This, together with nerve conduction studies consistent with Guillain-Barré syndrome, resulted in the delayed recognition of rhabdomyolysis in these cases.
  
  
  CONCLUSIONS
  The addition of fusidic acid can precipitate rhabdomyolysis in patients with diabetes already taking a statin. This can present with rapidly progressive weakness resembling Guillain-Barré syndrome. We recommend that creatine kinase is checked in patients with diabetes on statin therapy who present with profound weakness and routinely in those commenced on prolonged courses of fusidic acid.
authors.affiliation: Renal Unit, Glasgow Royal Infirmary, Glasgow, UK. tara.collidge@nhs.net
authors.forename: T A
authors.initials: TA
authors.lastname: Collidge
authors.forename: S
authors.initials: S
authors.lastname: Razvi
authors.forename: C
authors.initials: C
authors.lastname: Nolan
authors.forename: M
authors.initials: M
authors.lastname: Whittle
authors.forename: C
authors.initials: C
authors.lastname: Stirling
authors.forename: A J C
authors.initials: AJ
authors.lastname: Russell
authors.forename: A C
authors.initials: AC
authors.lastname: Mann
authors.forename: C J
authors.initials: CJ
authors.lastname: Deighan
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000188:drug therapy*; D003937:Diagnosis, Differential; D004347:Drug Interactions; D005260:Female; D005672:Fusidic Acid / Q000009:adverse effects*; D020275:Guillain-Barre Syndrome / Q000139:chemically induced; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012206:Rhabdomyolysis / Q000139:chemically induced*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D005672:Fusidic Acid