Srinivasan Varshini, Prabu Samyuktha, Sfeir Jad G, Muthusamy Kalpana
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA.
Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA.
JCEM Case Rep. 2024 Dec 6;2(12):luae227. doi: 10.1210/jcemcr/luae227. eCollection 2024 Dec.
The widespread use of statins for cardiovascular diseases has unveiled a new subset of inflammatory myopathy, immune-mediated necrotizing myopathy (IMNM). We describe below an unusual case of anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) myopathy. A 64-year-old male individual with type 2 diabetes, hyperlipidemia, and coronary artery disease presented with progressive proximal muscle weakness and pain for 3 months. He took atorvastatin 40 mg for 4 years, which was discontinued due to elevated liver enzymes and resumed treatment with rosuvastatin 5 mg later due to worsening hyperlipidemia. Physical examination showed significant weakness of the hip, shoulder girdle, and biceps/triceps. Creatinine kinase (CK) was found to be 232.48 µkat/L (13 921 IU/L) (normal: 0.833-5.133 µkat/L; 50-308 IU/L). Electromyography and left vastus lateralis muscle biopsy showed findings of myonecrosis. Anti-HMGCR assay was strongly positive with antibodies > 200 chemiluminescent units (CU) (normal: 0-20 CU). He was started on prednisone followed by human-immunoglobulin (IVIG) which led to a decline in CK. Statin-induced necrotizing autoimmune myopathy (SINAM) is an exceptionally rare side effect of statins. Although statins come with a good side-effect profile, one should be aware of marked, persistent elevations in muscle enzyme levels. Prompt confirmation with antibody levels, drug discontinuation, and early initiation of immunosuppression can lead to good outcomes.
他汀类药物在心血管疾病中的广泛应用揭示了一种新的炎性肌病亚型——免疫介导的坏死性肌病（IMNM）。我们在下文描述了一例不寻常的抗3-羟基-3-甲基戊二酰辅酶A还原酶（抗HMGCR）肌病病例。一名64岁男性，患有2型糖尿病、高脂血症和冠状动脉疾病，出现进行性近端肌无力和疼痛3个月。他服用阿托伐他汀40毫克达4年，因肝酶升高停药，后因高脂血症恶化恢复服用瑞舒伐他汀5毫克。体格检查显示髋部、肩胛带和肱二头肌/肱三头肌明显无力。发现肌酸激酶（CK）为232.48微卡/升（13921国际单位/升）（正常：0.833 - 5.133微卡/升；50 - 308国际单位/升）。肌电图和左股外侧肌活检显示有肌坏死表现。抗HMGCR检测抗体>200化学发光单位（CU）呈强阳性（正常：0 - 20 CU）。他开始使用泼尼松，随后使用人免疫球蛋白（IVIG），这导致CK下降。他汀类药物诱导的坏死性自身免疫性肌病（SINAM）是他汀类药物极为罕见的副作用。尽管他汀类药物副作用较小，但应注意肌肉酶水平显著、持续升高的情况。通过抗体水平迅速确诊、停药并尽早开始免疫抑制治疗可取得良好疗效。
