mmune-mediated necrotizing myopathy due to statins exposure

Luisa Villa 1 2, Alberto Lerario 1, Sonia Calloni 3, Lorenzo Peverelli 1, Caterina Matinato 4, Federica de Liso 4, Ferruccio Ceriotti 4, Roberto Tironi 1, Monica Sciacco 1, Maurizio Moggio 1, Fabio Triulzi 3 and Claudia Cinnante 3

1 Neuromuscular and Rare Disease Unit, Department of Neuroscience, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Italy; 2 Neuromuscular Disease Centre, Department of Clinical Neurosciences, University Hospital of Nice (CHU), France; 3 Neuroradiology Unit, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy; 4 Laboratorio analisi, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

Statin-induced necrotizing autoimmune myopathy (IMNM) is an autoimmune disorder induced by anti-3-hydroxy-3-methylglutaryl-coenzyme-A reductase (anti-HMGCR) antibodies. We performed a retrospective clinical, histological, and radiological evaluation of 5 patients with a 3-year therapeutic follow-up. All patients used statins and then experienced proximal weakness that persisted after drug cessation. Muscle biopsies revealed a primary necrotizing myopathy without inflammatory infiltrates. All patients required immunomodulant combination therapy to achieve clinical remission. Magnetic resonance imaging (MRI) showed the presence of edema in the medial gastrocnemius, posterior and central loggia of the thigh, posterior loggia of the arm, and the infraspinatus and subscapularis muscles, as well as extensive inflammation of the subcutaneous tissues and muscolaris fasciae. Serum analysis, muscle biopsy, and MRI are fundamental for IMNM diagnosis and follow-up. The growing use of statins in the general population raises the importance of acquaintance with this disease in clinical practice.

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