Gómez-Pérez Francisco J, Chiquete-Anaya Erwin, Moncayo-Sánchez Andrea G, Gamboa-Domínguez Armando, Aguilar-Salinas Carlos A, Mehta Roopa
Department of Endocrinology and Lipid Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico.
Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico.
JCEM Case Rep. 2025 Mar 27;3(5):luaf037. doi: 10.1210/jcemcr/luaf037. eCollection 2025 May.
Statins are a group of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors aimed at reducing cholesterol synthesis. Since their discovery in 1970, their use has exponentially increased, becoming a regular preventive treatment for cardiovascular diseases. Among their most common adverse effects are myopathies, with the most severe being autoimmune necrotizing myopathy. We present a case of a woman in her 70s, with high cardiovascular-risk comorbid conditions, including autoimmune hypothyroidism, type 2 diabetes, arterial hypertension, and dyslipidemia. After 5 years on atorvastatin, she developed proximal limb weakness and elevated creatine kinase and creatine kinase-MB levels. A muscle biopsy showed autoimmune necrotizing myopathy and blood work confirmed positive 3-hydroxy-3-methylglutaryl coenzyme A reductase antibodies. Based on these findings, a diagnosis of statin-associated autoimmune necrotizing myopathy was made. In this case, treatment with intravenous immunoglobulin and rituximab resulted in complete remission.
他汀类药物是一类旨在降低胆固醇合成的3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂。自1970年被发现以来，其使用量呈指数级增长，成为心血管疾病的常规预防性治疗药物。其最常见的不良反应包括肌病，最严重的是自身免疫性坏死性肌病。我们报告一例70多岁的女性病例，她患有高心血管风险的合并症，包括自身免疫性甲状腺功能减退、2型糖尿病、动脉高血压和血脂异常。服用阿托伐他汀5年后，她出现近端肢体无力，肌酸激酶和肌酸激酶-MB水平升高。肌肉活检显示为自身免疫性坏死性肌病，血液检查证实3-羟基-3-甲基戊二酰辅酶A还原酶抗体呈阳性。基于这些发现，诊断为他汀类药物相关的自身免疫性坏死性肌病。在该病例中，静脉注射免疫球蛋白和利妥昔单抗治疗导致完全缓解。
