title: An Unusual Case of Statin-Induced Myopathy: Anti-HMGCoA Necrotizing Autoimmune Myopathy.
abstract: Statins are some of the most widely prescribed medications, and though generally well tolerated, can lead to a self-limited myopathy in a minority of patients. Recently, these medications have been associated with a necrotizing autoimmune myopathy (NAM). Statin-associated NAM is characterized by irritable myopathy on electromyography (EMG) and muscle necrosis with minimal inflammation on muscle biopsy. The case presented is a 63-year-old woman who has continued elevation of creatine kinase (CK) after discontinuation of statin therapy. She has irritable myopathy on EMG and NAM is confirmed by muscle biopsy. She subsequently tests positive for an experimental anti-3-hydroxy-3-methylglutaryl-coenzyme A (anti-HMGCoA) antibody that is found to be present in patients with statin-associated NAM. Though statin-associated NAM is a relatively rare entity, it is an important consideration for the general internist in patients who continue to have CK elevation and weakness after discontinuation of statin therapy. Continued research is necessary to better define statin-specific and dose-dependent risk, as well as optimal treatment for this condition.
authors: Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. lnichols@mcw.edu.
authors: Laura
authors: L
authors: Nichols
authors: Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors: Kurt
authors: K
authors: Pfeifer
authors: Department of Neurology, Johns Hopkins University School of Medicine Baltimore, Baltimore, MD, USA.|Department of Medicine, Johns Hopkins University School of Medicine Baltimore, Baltimore, MD, USA.|Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institutes of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health Bethesda, Bethesda, MD, USA.
authors: Andrew L
authors: AL
authors: Mammen
authors: Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors: Nazima
authors: N
authors: Shahnoor
authors: Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.|University of California, San Diego, San Diego, CA, USA.
authors: Chamindra G
authors: CG
authors: Konersman
mesh_terms: D000214:Acyl Coenzyme A / Q000276:immunology*; D000069059:Atorvastatin / Q000009:adverse effects*; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000473:pathology; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D009135:Muscular Diseases / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000214:Acyl Coenzyme A; D001323:Autoantibodies; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; C008047:3-hydroxy-3-methylglutaryl-coenzyme A; D000069059:Atorvastatin; D003402:Creatine Kinase
keywords: anti-HMGCR antibody; idiopathic inflammatory myopathy; necrotizing autoimmune myopathy; statin