European Journal of Rheumatology
Case based Review
A case of statin-associated immune-mediated necrotizing myopathy with atypical biopsy features

A case of statin-associated immune-mediated necrotizing myopathy with atypical biopsy features

1.

Department of Medicine, Harvard Medical School, Boston, MA, USA

2.

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

3.

Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA

4.

Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, MA, USA

Eur J Rheumatol 2021; 8: 36-39
DOI: 10.5152/eurjrheum.2020.20064
Read: 282 Downloads: 189 Published: 28 December 2020

Statin-associated immune-mediated necrotizing myopathy (IMNM) is a rare presentation of a statin-associated myopathy. Patients usually present with muscle weakness and pain in the setting of statin use with elevated creatine kinase (CK) levels and a positive anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibody. Muscle biopsies typically show necrosis, CD68+ macrophages, and minimal lymphocytes. We present a case of a 67-year-old woman who had 2 months of progressive weakness and bilateral lower extremity pain after initiating atorvastatin therapy with symptoms persisting after statin cessation. She was found to have high anti-HMGCR antibody titers, and the biopsy of the rectus femoris muscle showed a prominent endomysial inflammatory cell infiltrate with necrotic and regenerative fibers and an atypical extensive inflammatory infiltrate composed of both CD4+ helper T cells and CD8+ cytotoxic T cells. She showed symptom resolution and normalization of CK levels and inflammatory markers with treatment involving a prolonged prednisone taper and a brief course of azathioprine, which was stopped because of the adverse effects.

Cite this article as: Zaki MM, Virk ZM, Lopez D, Klubnick J, Ahrendsen JT, Varma H, et al. A case of statin-associated immune-mediated necrotizing myopathy with atypical biopsy features. Eur J Rheumatol 2021; 8(1): 36-9.

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ISSN 2147-9720 EISSN 2148-4279