Anti-HMGCR antibodies and asymptomatic hyperCKemia. A case report

Francesca Torri 1, Greta Ali 2, Lucia Chico 1, Gabriele Siciliano 1, Giulia Ricci 1

1Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy; 2 Department of Surgical Pathology, Medical, Molecular, and Critical Area, University of Pisa, Pisa, Italy

DOI 10.36185/2532-1900-050

Anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) related myositis is a form of immune-mediated necrotizing myopathy (IMNM). Anti-HMGCR autoantibodies target HMGCR, a glycoprotein linked to the endoplasmic reticulum implied in the cholesterol synthesis pathway, and exert a pathogenic effect on skeletal muscle cells. More than 60% of patients affected by HMGCR-related myositis shares statin-exposure in their medical history. Patients commonly experience CK levels elevation, myalgia, muscle weakness and soreness at variable extent, which manifest acutely or sub acutely with a progressively worsening course, in some cases mimicking limb-girdle muscular dystrophies (LGMD) phenotype and treatment is based on an immunosuppressive strategy. Here we present the peculiar case of a previously statins-exposed 72 y.o. asymptomatic man with persistent moderate hyperCKemia and high levels of anti-HMGCR, in which pharmacotherapy has not been initiated yet, while a wait-and-see approach has been adopted instead. 

Scarica il PDF