title: [Immune-mediated necrotizing myopathy associated with antibodies to hydroxy-methyl-glutaryl-coenzyme A reductase].
abstract: BACKGROUND
  Statins or 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (HMGCR) are among the most commonly prescribed treatment in France. They may be responsible for muscular intolerance with variable severity. They have been recently involved in the occurrence of an acquired inflammatory myopathy associated with anti-HMGCR antibodies. This new type of toxic myopathy remains poorly known by clinicians.
  
  
  METHODS
  We report a 61-year-old woman treated with a statin for many years who developed a lower and upper limb disabling myopathy with a rapid unfavourable course despite treatment withdrawal. Clinical history and investigations, especially including an assay for anti-HMGCR antibodies led to the diagnosis of autoimmune necrotizing myopathy with anti-HMGCR antibodies. Subsequent initiation of an immunosuppressive treatment by corticosteroids and methotrexate was effective.
  
  
  CONCLUSIONS
  Statins may unmask or cause an autoimmune necrotizing myopathy associated with the presence of anti-HMGCR antibodies. Their identification is now routinely available. An immunosuppressive treatment is necessary and justified by the autoimmune nature of the disease.
authors.affiliation: Service de médecine interne-soins continus, centre hospitalier Emile-Muller, 20, rue du Dr-René-Laennec, 68070 Mulhouse, France. Electronic address: hinschbergero@ch-mulhouse.fr.
authors.forename: O
authors.initials: O
authors.lastname: Hinschberger
authors.affiliation: Laboratoire de microbiologie, centre hospitalier Emile-Muller, 20, rue du Dr-René-Laennec, 68070 Mulhouse, France.
authors.forename: C
authors.initials: C
authors.lastname: Lohmann
authors.affiliation: Service de pathologie, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Lannes
authors.affiliation: Service de médecine interne-soins continus, centre hospitalier Emile-Muller, 20, rue du Dr-René-Laennec, 68070 Mulhouse, France.
authors.forename: L
authors.initials: L
authors.lastname: Martzolff
authors.affiliation: Service de médecine interne-soins continus, centre hospitalier Emile-Muller, 20, rue du Dr-René-Laennec, 68070 Mulhouse, France.
authors.forename: B D
authors.initials: BD
authors.lastname: Vo
authors.affiliation: Service de médecine interne-soins continus, centre hospitalier Emile-Muller, 20, rue du Dr-René-Laennec, 68070 Mulhouse, France.
authors.forename: F
authors.initials: F
authors.lastname: Jaeger-Bizet
authors.affiliation: Service de médecine interne-soins continus, centre hospitalier Emile-Muller, 20, rue du Dr-René-Laennec, 68070 Mulhouse, France.
authors.forename: E
authors.initials: E
authors.lastname: Ciobanu
authors.affiliation: Service de médecine interne-soins continus, centre hospitalier Emile-Muller, 20, rue du Dr-René-Laennec, 68070 Mulhouse, France.
authors.forename: P
authors.initials: P
authors.lastname: Kieffer
mesh_terms: D001323:Autoantibodies / Q000097:blood*; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D015415:Biomarkers / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D009135:Muscular Diseases / Q000139:chemically induced* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D009336:Necrosis; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D005938:Glucocorticoids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents; D008727:Methotrexate
keywords: Anti-3-hydroxy-3-methyl-glutaryl-coenzyme A reductase antibodies; Anticorps anti-3-hydroxy-3-méthyl-glutaryl-coenzyme A réductase; Myopathie nécrosante; Myotoxicity; Necrotizing myopathy; Statines; Statins; Toxicité musculaire