Persisting weakness after withdrawal of a statin.
An 81-year-old woman treated with simvastatin for several years followed by atorvastatin for about 1 year presented with fatigue, weakness and unsteady gait. The finding of elevated creatine kinase (CK) and symmetric muscle weakness around shoulders and hips led to suspicion of a toxic statin-associated myopathy. Atorvastatin was withdrawn, but her weakness persisted. Owing to persisting weakness, an autoimmune myopathy (myositis) was suspected, but initially disregarded since a muscle biopsy showed necrotic muscle fibres without inflammatory cell infiltrates and myositis-specific autoantibodies were absent. After 18 months with slowly progressive weakness and increasing CK values, awareness of new knowledge about autoimmunity as a cause of necrotic myopathy, led to a successful treatment trial with intravenous immunoglobulines, followed by steroids and metothrexate. Antibodies to the target enzyme of statins (HMGCR (3-hydroksy-3-methylglutaryl-coenzyme A reductase)) were detected in her serum, and she was diagnosed with autoimmune necrotic myositis probably triggered by atorvastatin.
Department of Neurology, Sørlandet Hospital, University of Bergen, Kristiansand, Norway.
Åse
Å
Mygland
Unn
U
Ljøstad
Bård Kronen
BK
Krossnes
D000369:Aged, 80 and over; D000069059:Atorvastatin; D001327:Autoimmune Diseases / Q000139:chemically induced*; D005260:Female; D006538:Heptanoic Acids / Q000009:adverse effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D018908:Muscle Weakness / Q000139:chemically induced* / Q000276:immunology*; D009220:Myositis / Q000139:chemically induced* / Q000276:immunology*; D009336:Necrosis / Q000139:chemically induced / Q000276:immunology; D011758:Pyrroles / Q000009:adverse effects*
D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin