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In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years.
Summary
A large percentage of the US population is either receiving or should be considered for statin therapy. Whether through primary or secondary prevention for atherosclerotic disease, statins remain one of the mainstay options available to physicians. Myalgias are the most commonly reported side effects, though largely self-limited and subjective in nature. Here, we report a case of drug-related myonecrosis following long-term use of atorvastatin. Prompt recognition of the condition and initiation of treatment is paramount to control the disease’s progression. While high-dose steroids are first line, quick escalation to methotrexate, IVIG or rituximab should be considered in refractory cases. This decision is guided by monitoring of serum markers such as CK and transaminases. The goal is quick normalisation of these enzymes, signalling cessation of underlying muscle necrosis. Patients may never regain full function and treatment can last months to years.
Background
Statin therapy is a mainstay option for treatment of primary and secondary prevention of cardiovascular adverse events, driven primarily by atherosclerotic cardiovascular disease (ASCVD) risk stratification. This has resulted in nearly 25% of the US adult population receiving a form of statin with an additional 10 million more qualifying to be considered for initiation of the drug.1 Although generally well-tolerated, myalgias remain the most reported side effect. While this side effect has a large prevalence throughout the data, patient’s preconceived notions and priming to ‘statin induced myalgias’ are also likely contributing factors.2 More concerning is drug-related myonecrosis, with an incidence of less than 0.5%. …
Footnotes
Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: BA, JF and BR. BA helped in the conception of the case, formulated the main draft for the submission in each section. He also conducted and transcribed the patient interview. BA further contributed to the overarching literature review in statin-induced myopathy cases to prepare the manuscript. He performed continued edits of the manuscript for submission. Lastly, he was involved in the direct care of the patient during his hospitalisation. JF performed a comprehensive literature review of the cases, treatment, prognosis and clinical course of statin-induced myopathies. He further contributed to producing the manuscript, specifically in the introduction and summary sections. JF was involved in the overall scheme and edits as well. BR serves as the principal investigator and attending physician in the patient’s case and care. He provided edits throughout the writing process and helped with the foundation and creation of the manuscript. BR also was involved with the conception and design of the manuscript. The following authors gave final approval of the manuscript: BR.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.