Rheumatology, Sligo University Hospital, Sligo, Ireland
Department of Medicine, Sligo University Hospital, Sligo, Ireland.
BMJ Case Rep. 2021 Apr 15;14(4):e240865. doi: 10.1136/bcr-2020-240865.
Statin-induced necrotising autoimmune myopathy (SINAM), a rare complication of statin use, presents with significant proximal muscle weakness and raised creatine kinase (CK) levels (50-100 times). This is different from other musculoskeletal conditions caused by statin use. Anti-hydroxy-methyl-glutaryl-coenzyme A reductase (HMG-CoA) reductase antibody is usually positive in SINAM and it generally indicates good response to immunosuppressive medications. We report a case of a 52-year-old man who presented with a 2-month history of significant upper and lower extremity proximal muscle weakness and a CK level of >10 000. He was started on atorvastatin for myocardial infarction 3 years ago. MRI pelvis, including proximal thigh, showed diffuse muscle oedema to all muscle groups. Muscle biopsy was suggestive of necrotising myopathy. His HMG-CoA reductase antibody was also positive. His treatment regimen consisted of immunosuppressants, including steroids. He also required extensive physiotherapy and showed response to treatment when reviewed in the outpatient clinic 9 months later.
他汀类药物诱导的坏死性自身免疫性肌病（SINAM）是他汀类药物使用的一种罕见并发症，表现为明显的近端肌无力和肌酸激酶（CK）水平升高（50-100 倍）。这与他汀类药物引起的其他肌肉骨骼疾病不同。SINAM 患者通常抗羟甲基戊二酰辅酶 A 还原酶（HMG-CoA）还原酶抗体阳性，通常表明对免疫抑制药物有良好的反应。我们报告了一例 52 岁男性，他有 2 个月的严重上下肢近端肌无力病史和 CK 水平>10000。他 3 年前因心肌梗死开始服用阿托伐他汀。骨盆 MRI，包括大腿近端，显示所有肌肉群均有弥漫性肌肉水肿。肌肉活检提示坏死性肌病。他的 HMG-CoA 还原酶抗体也呈阳性。他的治疗方案包括免疫抑制剂，包括类固醇。他还需要广泛的物理治疗，在 9 个月后的门诊就诊时显示出对治疗的反应。
