A case of statin-associated immune-mediated necrotizing myopathy with atypical biopsy features
| Autor: | Zain M Virk, Diego B. Lopez, Mark M. Zaki, Vasileios C. Kyttaris, Hemant Varma, Jenna Klubnick, Ilana Abeles, Jared T. Ahrendsen |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
lcsh:Immunologic diseases. Allergy
Weakness Pathology medicine.medical_specialty Statin Case-based Review medicine.diagnostic_test biology medicine.drug_class business.industry Muscle weakness Azathioprine Prednisone Biopsy medicine biology.protein lipids (amino acids peptides and proteins) Creatine kinase medicine.symptom lcsh:RC581-607 business Myopathy medicine.drug |
| Zdroj: | European Journal of Rheumatology, Vol 8, Iss 1, Pp 36-39 (2021) Eur J Rheumatol |
| ISSN: | 2148-4279 |
| DOI: | 10.5152/eurjrheum.2020.20064 |
| Popis: | Statin-associated immune-mediated necrotizing myopathy (IMNM) is a rare presentation of a statin-associated myopathy. Patients usually present with muscle weakness and pain in the setting of statin use with elevated creatine kinase (CK) levels and a positive anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibody. Muscle biopsies typically show necrosis, CD68+ macrophages, and minimal lymphocytes. We present a case of a 67-year-old woman who had 2 months of progressive weakness and bilateral lower extremity pain after initiating atorvastatin therapy with symptoms persisting after statin cessation. She was found to have high anti-HMGCR antibody titers, and the biopsy of the rectus femoris muscle showed a prominent endomysial inflammatory cell infiltrate with necrotic and regenerative fibers and an atypical extensive inflammatory infiltrate composed of both CD4+ helper T cells and CD8+ cytotoxic T cells. She showed symptom resolution and normalization of CK levels and inflammatory markers with treatment involving a prolonged prednisone taper and a brief course of azathioprine, which was stopped because of the adverse effects. |
| Databáze: | OpenAIRE |
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