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Dysphagia: A Case Report of an Atypical Presentation of Statin-Induced Necrotizing Myositis

Statin medications act by inhibiting the enzyme hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase (HMGCR), thus decreasing hepatic cholesterol synthesis. They are considered the mainstay treatment of hypercholesterolemia due to their tremendous efficacy and mortality benefit. Although generall...

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Autores principales: Polmann, Michaela B, Suarez, Richard I, Saad, Ali, Bedran, Kebir H
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503781/
https://www.ncbi.nlm.nih.gov/pubmed/37719573
http://dx.doi.org/10.7759/cureus.43587
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author Polmann, Michaela B
Suarez, Richard I
Saad, Ali
Bedran, Kebir H
author_facet Polmann, Michaela B
Suarez, Richard I
Saad, Ali
Bedran, Kebir H
author_sort Polmann, Michaela B
collection PubMed
description Statin medications act by inhibiting the enzyme hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase (HMGCR), thus decreasing hepatic cholesterol synthesis. They are considered the mainstay treatment of hypercholesterolemia due to their tremendous efficacy and mortality benefit. Although generally well tolerated, statins may adversely affect skeletal muscle resulting in side effects ranging from mild myalgia to life-threatening necrotizing myositis. Statin-induced necrotizing autoimmune myositis is a rare yet devastating adverse effect that may occur shortly after initiation of therapy or after several years of use. Unfortunately, medication discontinuation has shown no impact on prevention or alleviation of symptoms. Though there is currently no definitive guidance for the treatment of this condition, corticosteroids are generally considered to be first line, via high-dose oral prednisone or intravenous methylprednisolone. In this case report, we discuss the case of a 72-year-old male with an unusual presentation of statin-induced necrotizing autoimmune myositis: dysphagia, weakness, and weight loss. His diagnosis was confirmed by muscle biopsy indicating necrotizing myositis and his serum was found to be strongly positive for anti-HMG-CoA reductase antibodies. This patient had a very brief history of statin use, but his primary care provider discontinued the medication a couple of months prior to symptom onset due to elevated liver function tests. He was treated with aggressive intravenous fluid hydration and intravenous corticosteroids during an extended inpatient hospital stay. He was discharged to a rehabilitation facility. This report demonstrates the importance of creating a wide differential for patients who present with fatigue, generalized weakness, and dysphagia. It is essential to always consider statin-induced necrotizing myositis if a patient has a history of statin use, even if the statin has been discontinued. Necrotizing myositis demands timely diagnosis and management to improve mortality.
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spelling pubmed-105037812023-09-16 Dysphagia: A Case Report of an Atypical Presentation of Statin-Induced Necrotizing Myositis Polmann, Michaela B Suarez, Richard I Saad, Ali Bedran, Kebir H Cureus Internal Medicine Statin medications act by inhibiting the enzyme hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase (HMGCR), thus decreasing hepatic cholesterol synthesis. They are considered the mainstay treatment of hypercholesterolemia due to their tremendous efficacy and mortality benefit. Although generally well tolerated, statins may adversely affect skeletal muscle resulting in side effects ranging from mild myalgia to life-threatening necrotizing myositis. Statin-induced necrotizing autoimmune myositis is a rare yet devastating adverse effect that may occur shortly after initiation of therapy or after several years of use. Unfortunately, medication discontinuation has shown no impact on prevention or alleviation of symptoms. Though there is currently no definitive guidance for the treatment of this condition, corticosteroids are generally considered to be first line, via high-dose oral prednisone or intravenous methylprednisolone. In this case report, we discuss the case of a 72-year-old male with an unusual presentation of statin-induced necrotizing autoimmune myositis: dysphagia, weakness, and weight loss. His diagnosis was confirmed by muscle biopsy indicating necrotizing myositis and his serum was found to be strongly positive for anti-HMG-CoA reductase antibodies. This patient had a very brief history of statin use, but his primary care provider discontinued the medication a couple of months prior to symptom onset due to elevated liver function tests. He was treated with aggressive intravenous fluid hydration and intravenous corticosteroids during an extended inpatient hospital stay. He was discharged to a rehabilitation facility. This report demonstrates the importance of creating a wide differential for patients who present with fatigue, generalized weakness, and dysphagia. It is essential to always consider statin-induced necrotizing myositis if a patient has a history of statin use, even if the statin has been discontinued. Necrotizing myositis demands timely diagnosis and management to improve mortality. Cureus 2023-08-16 /pmc/articles/PMC10503781/ /pubmed/37719573 http://dx.doi.org/10.7759/cureus.43587 Text en Copyright © 2023, Polmann et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Polmann, Michaela B
Suarez, Richard I
Saad, Ali
Bedran, Kebir H
Dysphagia: A Case Report of an Atypical Presentation of Statin-Induced Necrotizing Myositis
title Dysphagia: A Case Report of an Atypical Presentation of Statin-Induced Necrotizing Myositis
title_full Dysphagia: A Case Report of an Atypical Presentation of Statin-Induced Necrotizing Myositis
title_fullStr Dysphagia: A Case Report of an Atypical Presentation of Statin-Induced Necrotizing Myositis
title_full_unstemmed Dysphagia: A Case Report of an Atypical Presentation of Statin-Induced Necrotizing Myositis
title_short Dysphagia: A Case Report of an Atypical Presentation of Statin-Induced Necrotizing Myositis
title_sort dysphagia: a case report of an atypical presentation of statin-induced necrotizing myositis
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503781/
https://www.ncbi.nlm.nih.gov/pubmed/37719573
http://dx.doi.org/10.7759/cureus.43587
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