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- Title
A case of statin-associated immune-mediated necrotizing myopathy with atypical biopsy features.
- Authors
Zaki, Mark M.; Virk, Zain M.; Lopez, Diego; Klubnick, Jenna; Ahrendsen, Jared T.; Varma, Hemant; Kyttaris, Vasileios; Abeles, Ilana
- Abstract
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.
- Subjects
T helper cells; CYTOTOXIC T cells; RECTUS femoris muscles; MUSCLE diseases; MUSCLE weakness
- Publication
European Journal of Rheumatology, 2021, Vol 8, Issue 1, p36
- ISSN
2148-4279
- Publication type
Article
- DOI
10.5152/eurjrheum.2020.20064