gms | German Medical Science

Statins are the most common group of cholesterol lowering medications with more than 100 million prescriptions per year. Statin induced muscular adverse effects occur in 10-25% of patients. We present two cases with Statin- induced necrotizing myopathy. A 70 year old man presented with acute kidney failure due to severe rhabdomyolysis and high creatine kinase (CK) levels. He had a six year history of low dose Statin therapy. Stopping Statin medication led to a fast recovery of muscle related symptoms and CK normalized quickly. A 63 year old woman presented with muscle pain, proximal muscle weakness and mild tetraparesis. She also had been on Statin medication. However, symptoms persisted after Statin had been withdrawn for a period of six months. The two clinical presentations with similar histopathology but different clinical behaviour after Statin- arrest suggest a different pathogenesis. The exact mechanism of Statin-associated myopathies (SAM) still remains elusive. However, a self- limiting Statin induced primarily toxic necrotizing myopathy is now distinguished from a persisting autoimmune mediated Statin- induced necrotizing myopathy. In the latter Anti-HMG- CoA- Reductase- Antibodies can be detected in the serum and muscle of affected patients. Statin-induced autoimmune mediated myopathy was confirmed in the second patient. Neuropathologists should be aware of the possibility of autoimmune mediated Statin- induced necrotizing myopathy and should recommend Anti-HMG-CoA-reductase- Antibody testing in all patients with persistent muscle pathology after Statin-arrest.