他汀类药物通过抑制酶羟基-3-甲基戊二酰辅酶A(HMG-CoA)还原酶(HMGCR)起作用,从而降低肝脏胆固醇的合成。由于其巨大的功效和死亡率益处,它们被认为是高胆固醇血症的主要治疗方法。虽然一般耐受性良好,他汀类药物可能会对骨骼肌产生不利影响,导致副作用从轻度肌痛到危及生命的坏死性肌炎。他汀类药物诱导的坏死性自身免疫性肌炎是一种罕见但破坏性的不良反应,可能在开始治疗后不久或使用数年后发生。不幸的是,停药对预防或缓解症状没有影响。虽然目前尚无治疗这种疾病的明确指导,皮质类固醇通常被认为是一线,通过大剂量口服泼尼松或静脉注射甲基泼尼松龙。在这个案例报告中,我们讨论了一个72岁的男性,他汀类药物诱导的坏死性自身免疫性肌炎的异常表现:吞咽困难,弱点,和减肥。肌肉活检证实了他的诊断,表明坏死性肌炎,并且发现他的血清对抗HMG-CoA还原酶抗体呈强烈阳性。这个病人使用他汀类药物的历史很短,但由于肝功能检查升高,他的初级保健提供者在症状发作前几个月停止了药物治疗。在长期住院期间,他接受了积极的静脉补液和静脉皮质类固醇治疗。他被送往康复机构。本报告证明了为疲劳患者创造广泛差异的重要性,广义弱点,和吞咽困难.如果患者有他汀类药物使用史,必须始终考虑他汀类药物引起的坏死性肌炎。即使他汀类药物已停用.坏死性肌炎需要及时诊断和治疗以提高死亡率。
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.