难以下咽的苦果：两例他汀类药物诱导的坏死性自身免疫性肌病表现为吞咽困难和转氨酶升高。
A tough pill to swallow: Two cases of statin-induced necrotizing autoimmune myopathy manifesting as dysphagia and transaminitis.
作者信息
Chaudhry Hunza, Lin Joanne, Atefi Rameen, Hagino Jeffrey, Yuvienco Candice Marie, Roytman Marina
机构信息
Department of Internal Medicine, University of California San Francisco, Fresno, CA, USA.
Department of Rheumatology, University of California San Francisco, Fresno, CA, USA.
出版信息
SAGE Open Med Case Rep. 2023 Jan 17;11:2050313X221150583. doi: 10.1177/2050313X221150583. eCollection 2023.
Although 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors are well tolerated, a small subset of patients may develop autoimmune myopathy, classified as immune-mediated necrotizing myopathy. Statin-induced immune-mediated necrotizing myopathy can present as proximal muscle weakness and in some cases as dysphagia and respiratory distress. We present two cases of patients taking statins who developed dysphagia and muscle weakness found to have statin-induced immune-mediated necrotizing myopathy. Both patients were treated with immunosuppressive therapy: one did well clinically, while the other had an aggressive form of statin-induced immune-mediated necrotizing myopathy and succumbed to the disease. Although statin-induced immune-mediated necrotizing myopathy is rare, early treatment to induce remission of this disabling condition should be initiated to prevent morbidity and mortality.
尽管3-羟基-3-甲基戊二酰辅酶A（HMG-CoA）还原酶抑制剂耐受性良好，但一小部分患者可能会发生自身免疫性肌病，归类为免疫介导的坏死性肌病。他汀类药物诱导的免疫介导的坏死性肌病可表现为近端肌无力，在某些情况下还可表现为吞咽困难和呼吸窘迫。我们报告了两例服用他汀类药物的患者，他们出现了吞咽困难和肌无力，经检查发现患有他汀类药物诱导的免疫介导的坏死性肌病。两名患者均接受了免疫抑制治疗：一名患者临床效果良好，而另一名患者患有侵袭性他汀类药物诱导的免疫介导的坏死性肌病，最终死于该病。尽管他汀类药物诱导的免疫介导的坏死性肌病很少见，但应尽早开始治疗以诱导这种致残性疾病缓解，以预防发病和死亡。
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