
María de los Ángeles Chávez Corona
Hospital Angeles Clínica Londres , MexicoTitle: Antibody miopathy associated with Anti-Hydroximethylglutaryl coenzyme-a reductase in a simvastatin user. a case report
Abstract
Adverse effects caused by statins, are usually well
tolerated. However, their use has been related to
several myopathic syndromes, such as: creatin
kinase (CK) elevation, myalgia, weakness,
myositis, and even fatal rhabdomyolysis. We
describe a case of immunomediated necrotizing
myopathy, who presented uncommon
manifestations like proximal weakness, dysarthria,
dysphagia and cervical muscle weakness. It is
important suspect this pathology even though it
does not present in a common way, mainly in
patients with risk factors, such as statin users.
A 53-year-old man, simvastatin user, presented
with myalgias, progressive muscular weakness,
and elevated transaminases and CK. The magnetic
resonance imaging (MRI) showed fatty infiltration
in the muscles and edema. The electromyography
showed a polyneuromyopathic pattern. Typical and
specific myositis-related antibiodies were negative.
The muscular biopsy did not show signs of an
inflammatory infiltration. The diagnosis of
immune-mediated necrotizing myopathy related to
statins was confirmed by the clinical data and the
presence of anti-hydroximethylglutaryl coenzymeA reductase (anti-HMG-CoA) antibodies. The drug
was discontinued, and steroids were started, with
subsequent improvement; however, the patient
presented a reappearance of symptoms and an
elevation of enzymes, for which intravenous
immunoglobulin was started with a favorable
outcome.
Conclusions: Immune mediated necrotizing
myopathy in statin users must be considered and
differentiated from other autoimmune entities such
as inclusion body myopathy, dermatomyositis and
polymyositis, as this will determine the therapeutic
plan and patient prognosis.
Biography
Maria de los Angeles completed her internal
medicine specialty at the age of 29 years from
Universidad Nacional Autonoma de México,
México.
She has collaborated in different national research
projects in Mexico and has collaborated in a book
chapter for the Internal Medicine Council in
Mexico