Cor Vasa 2024, 66(6):620-622 | DOI: 10.33678/cor.2024.037

A hard pill to swallow - statin-induced necrotizing autoimmune myopathy manifesting as dysphagia

Rita Veiga, Nuno Cotrim, Catarina Coelho, Beatriz Andrade, Kevin Domingues
Hospital Distrital de Santarém, Santarém, Portugal

Background: Statin-induced necrotizing autoimmune myopathy (SINAM) is a very rare and devastating complication of statin therapy. Case presentation: We report a case of a 70 year-old-male who presented in the ER with progressive proximal muscle weakness, dysphagia, and myalgia for the past 4 months. He was medicated in the previous 2 years with 40 mg atorvastatin. On admission, his blood analysis revealed elevated CPK (22086 U/L). Although the patient suspended statin therapy, CPK values remained high and his symptoms persisted. The autoimmune study was notable for strongly positive HMGCR antibody. Deltoid muscle biopsy revealed muscle-cell necrosis and regeneration. These clinical, analytical, and histologic features were consistent with a diagnosis of SINAM.

Conclusions: The patient was started on oral steroids with substantial clinical and analytical improvement. Adult-onset necrotizing myopathy is also strongly associated with an increased risk of cancer.

Keywords: Dyslipidaemia, Necrotizing autoimmune myopathy, Statin

Received: April 12, 2024; Revised: April 17, 2024; Accepted: May 1, 2024; Prepublished online: December 4, 2024; Published: December 20, 2024  Show citation

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Veiga R, Cotrim N, Coelho C, Andrade B, Domingues K. A hard pill to swallow - statin-induced necrotizing autoimmune myopathy manifesting as dysphagia. Cor Vasa. 2024;66(6):620-622. doi: 10.33678/cor.2024.037.
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