Villa Luisa, Lerario Alberto, Calloni Sonia, Peverelli Lorenzo, Matinato Caterina, DE Liso Federica, Ceriotti Ferruccio, Tironi Roberto, Sciacco Monica, Moggio Maurizio, Triulzi Fabio, Cinnante Claudia
Neuromuscular and Rare Disease Unit, Department of Neuroscience, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Italy.
Neuromuscular Disease Centre, Department of Clinical Neurosciences, University Hospital of Nice (CHU), France.
Acta Myol. 2018 Dec 1;37(4):257-262. eCollection 2018 Dec.
Statin-induced necrotizing autoimmune myopathy (IMNM) is an autoimmune disorder induced by anti-3-hydroxy-3-methylglutaryl-coenzyme-A reductase (anti-HMGCR) antibodies. We performed a retrospective clinical, histological, and radiological evaluation of 5 patients with a 3-year therapeutic follow-up. All patients used statins and then experienced proximal weakness that persisted after drug cessation. Muscle biopsies revealed a primary necrotizing myopathy without inflammatory infiltrates. All patients required immunomodulant combination therapy to achieve clinical remission. Magnetic resonance imaging (MRI) showed the presence of edema in the medial gastrocnemius, posterior and central loggia of the thigh, posterior loggia of the arm, and the infraspinatus and subscapularis muscles, as well as extensive inflammation of the subcutaneous tissues and muscolaris fasciae. Serum analysis, muscle biopsy, and MRI are fundamental for IMNM diagnosis and follow-up. The growing use of statins in the general population raises the importance of acquaintance with this disease in clinical practice.
他汀类药物诱导的坏死性自身免疫性肌病（IMNM）是一种由抗3-羟基-3-甲基戊二酰辅酶A还原酶（抗HMGCR）抗体诱导的自身免疫性疾病。我们对5例患者进行了回顾性临床、组织学和放射学评估，并进行了3年的治疗随访。所有患者均使用过他汀类药物，随后出现近端肌无力，停药后仍持续存在。肌肉活检显示为原发性坏死性肌病，无炎性浸润。所有患者均需要免疫调节联合治疗以实现临床缓解。磁共振成像（MRI）显示腓肠肌内侧、大腿后侧和中部肌间、手臂后侧肌间以及冈下肌和肩胛下肌存在水肿，以及皮下组织和肌筋膜广泛炎症。血清分析、肌肉活检和MRI对IMNM的诊断和随访至关重要。他汀类药物在普通人群中的使用日益增加，这凸显了在临床实践中认识这种疾病的重要性。
