| Abstract [eng] |
Background: Statin-induced necrotizing autoimmune myopathy is an extremely rare but severe complication of statin therapy, characterised by proximal muscle weakness, elevated creatine kinase levels and positive specific 3-hydroxy-3-methylglutaryl coenzyme A reductase antibodies. In such patients, liver transaminase elevations are also frequently observed. In clinical practice, it is important to distinguish whether the elevation of liver enzymes is of muscular origin or due to liver damage. Case report: A 70-year-old man was diagnosed with dyslipidemia after a myocardial infarction and prescribed atorvastatin. After increasing the dose several months later, muscle weakness developed and elevated myolytic and liver enzymes were found. Serological tests showed elevated 3-hydroxy-3-methylglutaryl coenzyme A reductase antibodies and muscle biopsy showed isolated necrotic myocytes, leading to the diagnosis of statin-induced autoimmune necrotizing myopathy. The patient was started treatment with methylprednisolone pulse therapy followed by oral glucocorticoids and plasmapheresis. Less than a year after the start of a treatment, prednisolone was discontinued as biochemical and clinical remission of the disease was achieved. However, the disease relapsed after complete discontinuation of glucocorticosteroids. Subsequently, prednisolone was reintroduced and the dose was gradually reduced, but after the relapse a complete remission of the disease has not yet been achieved. At the last visit to the rheumatologist, the patient stated that low-intensity thigh muscle pain persists, also there is an increase in the creatine kinase and transaminases. Since the beginning of the disease, the patient has been experiencing an increase in liver enzymes along with an increase in creatine kinase. The patient was therefore continuously investigated by gastroenterologist for possible hepatic pathology, but finally hepatic pathology was excluded and the transaminase increase was considered to be of muscular origin. It was recommended to follow the rheumatologist's instructions, to avoid polypharmacy and a moderate alcohol consumption. Conclusion: Statin-induced necrotizing autoimmune myopathy is very rare, so the optimal treatment choice remains unclear, but aggressive immunosuppression is necessary. Further clinical trials are needed to help clinicians choose a treatment regimen that prevents relapses after discontinuation of corticosteroids. Since an increase in the activity of liver enzymes is often detected, a detailed gastroenterological examination of the patient is necessary to specify or rule out liver pathology. |
