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Archivos de Medicina de Urgencia de México

2026, Number 1

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Arch Med Urg Mex 2026; 18 (1)

Statin-induced immune-mediated necrotizing myopathy: a diagnostic and therapeutic challenge a report of three extremely severe cases

Torres-Zapata A, Gómez-Ramíre LA, Berrouet-Mejía MC

Language: Spanish
References: 31
Page: 122-126
PDF size: 285.68 Kb.


ABSTRACT

Introduction: Statins are the cornerstone of cardiovascular disease prevention worldwide; however, their effectiveness can be limited by the occurrence of statin-associated muscle symptoms (SAMS). Although most cases are mild and self-limiting, a subset of patients develops severe forms such as rhabdomyolysis or immune- mediated necrotizing myopathy (IMNM)—a rare but potentially devastating condition mediated by autoantibodies against HMGCoA reductase. This condition requires a high index of clinical suspicion and specialized management to prevent permanent functional sequelae.
Objective: tto describe three clinical cases of severe statin-associated myopathy that progressed to rhabdomyolysis and acute kidney injury, in order to analyze the challenges in differential diagnosis, highlight the importance of identifying risk factors, and propose a timely, stratified therapeutic approach.
Case presentation: we present three patients who, while undergoing statin therapy, developed severe myopathy and rhabdomyolysis with massive elevations in creatine phosphokinase (CPK ›13,000 U/L), resulting in acute kidney injury requiring renal replacement therapy. The cases were associated with high doses of rosuvastatin, the combination of atorvastatin and rosuvastatin in the context of polypharmacy, and the exacerbation of underlying dermatomyositis. In all cases, progressive proximal muscle weakness and persistently elevated biomarkers persisted despite discontinuation of the drug.
Conclusions: these cases illustrate the spectrum of severity of statin-associated myotoxicity and reinforce the need for close clinical monitoring. Persistence of symptoms after discontinuing the statin should be considered a red flag for a possible underlying autoimmune mechanism. Early recognition and the initiation of aggressive immunosuppressive therapy are crucial for altering the prognosis of IMNM and optimizing the patient’s functional recovery.


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