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Patel PP, Jackson CD. When Statins Get Physical: A Curious Cause of Statin Myopathy. South Med J 2022; 115:266-269. [PMID: 35365843 DOI: 10.14423/smj.0000000000001379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We present the case of a 61-year-old male with hyperlipidemia and lumbar radiculopathy admitted to our hospital with rhabdomyolysis attributed to the recent initiation of statin therapy. Despite aggressive fluid resuscitation and an initial declination in his creatine phosphokinase (CPK) levels, he had persistent myalgias with progressive weakness. Rheumatologic and neurologic evaluation for other causes of myopathy were negative. Muscle biopsy obtained showed signs of necrosis and muscle regeneration. Given his recent statin use, persistent CPK elevation, proximal muscle weakness, and muscle biopsy findings, he was diagnosed as having statin-induced necrotizing autoimmune myopathy. He improved with the initiation of immunosuppressive therapy. Statin-induced necrotizing autoimmune myopathy is an underdiagnosed cause of myalgias, proximal muscle weakness, and significant CPK elevation that fails to respond to statin discontinuation and fluid resuscitation. Given the prevalence of statin use, internists need to have a high index of suspicion for this diagnosis in patients presenting with CPK elevations and muscle weakness who take statin therapy.
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Affiliation(s)
- Puja P Patel
- From the Department of Medicine, Division of General Internal Medicine, University of Tennessee Health Science Center, Memphis
| | - Christopher D Jackson
- From the Department of Medicine, Division of General Internal Medicine, University of Tennessee Health Science Center, Memphis
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Escher AR, Hoffman JP, Alfieri S, Bordoni B, Evans RM. Immune-Mediated Myopathy in a Patient Presenting for Melanoma Resection and Sentinel Lymph Node Biopsy. Cureus 2022; 14:e22777. [PMID: 35291729 PMCID: PMC8896259 DOI: 10.7759/cureus.22777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/02/2022] [Indexed: 12/02/2022] Open
Abstract
Statin-induced necrotizing autoimmune myopathy (SINAM) is a rare side effect in people who are taking a class of drugs called statins. Patients with SINAM will present with subacute severe symmetric proximal muscle weakness. In contrast to more common myopathies, SINAM may not spontaneously resolve with statin discontinuation. These patients may require long-term immunotherapy to limit further disease progression. In this case study, we report a 74-year-old female with SINAM who presented for radical excision of a right upper back melanoma and sentinel lymph node biopsy at an outpatient facility. An anesthetic plan was crafted with the use of a supraglottic airway device without neuromuscular blockade.
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Yang D, Lyu W, Hu Z, Gao J, Zheng Z, Wang W, Firrman J, Ren D. Probiotic Effects of Lactobacillus fermentum ZJUIDS06 and Lactobacillus plantarum ZY08 on Hypercholesteremic Golden Hamsters. Front Nutr 2021; 8:705763. [PMID: 34262929 PMCID: PMC8273167 DOI: 10.3389/fnut.2021.705763] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/27/2021] [Indexed: 12/19/2022] Open
Abstract
Hypercholesteremia or high cholesterol is one of the important factors leading to atherosclerosis and other cardiovascular diseases. The application of probiotics with cholesterol-lowering characteristics has become increasingly popular over the past decade due to their contribution to human health. This study aimed to evaluate the probiotic effects of Lactobacillus fermentum ZJUIDS06 and Lactobacillus plantarum ZY08 on hyperlipidemic golden hamsters. A hyperlipidemic model was established through a high cholesterol diet in golden hamsters, after which lyophilized Lactobacillus fermentum ZJUIDS06 and Lactobacillus plantarum ZY08 were orally administered individually for 8 weeks. The physiological characteristics of golden hamsters and short chain fatty acid (SCFA) in the colon were assessed by automatic Biochemical Analyzer and gas choromatograph, respectively. A MiSeq sequencing-based analysis of the bacterial 16S rRNA gene (V3–V4 region) in the cecum content was performed to analyze the cecum microbiota. Correlations between sets of these variables were also investigated using the R package “corrplot.” Results showed that neither Lactobacillus fermentum ZJUIDS06 nor Lactobacillus plantarum ZY08 inhibited body weight increase. However, supplementation with Lactobacillus fermentum ZJUIDS06 for 8 weeks increased colon SCFA levels (P < 0.05), decreased serum low-density lipoprotein, total cholesterol, and triglycerides levels, and also induced changes in the cecum microbiota of hyperlipidemic golden hamsters. Remarkably, oral administration of Lactobacillus fermentum ZJUIDS06 increased the relative abundance of Parabacteroides in the cecum, which served as a biomarker for colon SCFA production and improvement of serum cholesterol levels. In a word, Lactobacillus fermentum ZJUIDS06 improved hyperlipidemia in golden hamsters, which correlated with an increase in SCFA levels and relative abundance of Parabacteroides, indicating its potential importance in functional foods that can help lower cholesterol.
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Affiliation(s)
- Dongting Yang
- College of Animal Sciences, Institute of Dairy Science, Zhejiang University, Hangzhou, China
| | - Wentao Lyu
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-Products, Institute of Agro-Product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou, China
| | - Ziyi Hu
- College of Animal Sciences, Institute of Dairy Science, Zhejiang University, Hangzhou, China
| | - Jiting Gao
- College of Animal Sciences, Institute of Dairy Science, Zhejiang University, Hangzhou, China
| | - Zhiyao Zheng
- College of Animal Sciences, Institute of Dairy Science, Zhejiang University, Hangzhou, China
| | - Weijun Wang
- Zhejiang Yiming Food Co. Ltd., Wenzhou, China
| | - Jenni Firrman
- Dairy and Functional Foods Research Unit, Eastern Regional Research Center, Agricultural Research Service, U.S. Department of Agriculture, Wyndmoor, PA, United States
| | - Daxi Ren
- College of Animal Sciences, Institute of Dairy Science, Zhejiang University, Hangzhou, China
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Nikolic D, Banach M, Chianetta R, Luzzu LM, Pantea Stoian A, Diaconu CC, Citarrella R, Montalto G, Rizzo M. An overview of statin-induced myopathy and perspectives for the future. Expert Opin Drug Saf 2020; 19:601-615. [PMID: 32233708 DOI: 10.1080/14740338.2020.1747431] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Statins remain the most commonly prescribed lipid-lowering drug class for the treatment of atherosclerotic cardiovascular disease. Their well-recognized side effects are known as statin-associated muscle symptom (SAMS). Some advances in this field have been made in recent years, but the understanding of the mechanisms has lagged. Investigating the specific role of the anti-HMGCR autoantibody, pharmacokinetic genetic variants, characterization of the known phenotypes of statin toxicity, in relation to clinical markers of disease, is of high importance.Areas covered: We summarized currently available findings (on PubMed) related to SAMS and discussed the therapeutic approaches, risk factors, drug interactions, potential novel systems, algorithms and biomarkers for SAMS detection. CoQ10 supplementation has been suggested as a complementary approach to manage SAMS, while vitamin D levels may be useful for both the diagnosis and management.Expert Opinion/Commentary: Further studies might help to understand the easiest way to diagnose SAMS, suitable prevention and an effective non-statin therapy. This review sheds new light on the future directions in both research and clinical practice, which will help with rapid risk assessment, identification of the SAMS risk factors in order to decrease the incidence of statins' adverse effects, and the most effective therapy.
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Affiliation(s)
- Dragana Nikolic
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,BELSS, Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
| | - Roberta Chianetta
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,BELSS, Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Luca Marco Luzzu
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Camelia Cristina Diaconu
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Bucharest, Romania.,Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Roberto Citarrella
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Giuseppe Montalto
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Manfredi Rizzo
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
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Yao Z, Yuan P, Hong S, Li M, Jiang L. Clinical Features of Acute Rhabdomyolysis in 55 Pediatric Patients. Front Pediatr 2020; 8:539. [PMID: 33014933 PMCID: PMC7500160 DOI: 10.3389/fped.2020.00539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 07/27/2020] [Indexed: 12/27/2022] Open
Abstract
Objective: This study was designed to compare the clinical manifestations, laboratory tests, etiology, and prognosis of children with acute rhabdomyolysis (RM) at various ages. This study was designed to analyze the risk factors for acute kidney injury (AKI) in children with RM and to identify the role of neuromuscular and autoimmune disease in children with RM. Methods: Clinical data for 55 children with RM were collected and statistically analyzed. Patients were stratified to an infant group (G1) (age <1 year), preschool group (G2) (age 1-6 year), school-age group (G3) (age 7-11 year), and an adolescent group (G4) (age 12-16 year). Results: The top three clinical manifestations were dark urine (52.7%), myalgia (38.2%), and fever (23.8%). Patients in G1 had fever (71.4%), vomiting (77.8%), and urinalysis abnormalities (14.3%), without triad clinical manifestations. Fifty percent of patients in G4 group had myalgia; 70.8% had dark urine; 75% had abnormal urine tests. The most common cause in each age group was as follows: sepsis (57.1%) in G1; hereditary neuromuscular diseases (44.4%) in G2; immune diseases (40%) in G3; strenuous exercise (50%) in G4. Logistic regression analysis shown that AKI was not corelated with age, gender, or peak creatine phosphokinase. AKI was, however, associated with presence of an electrolyte disorder. Conclusion: The clinical manifestations and laboratory findings in infants with acute RM are not typical and need to be taken seriously. The presence of an electrolyte disorder is a risk factor for AKI in children with RM. The most common pathogenesis of RM varies among age groups. Congenital hereditary metabolic disease and immune diseases should not be ignored as a cause of RM in children.
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Affiliation(s)
- Zhengxiong Yao
- Department of Neurology, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Yuan
- Department of Neurology, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Siqi Hong
- Department of Neurology, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Mei Li
- Department of Neurology, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Li Jiang
- Department of Neurology, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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Pitlick M, Ernste F. Anti-HMGCR myopathy presenting with acute systolic heart failure. BMJ Case Rep 2019; 12:12/5/e230213. [PMID: 31068355 PMCID: PMC6506079 DOI: 10.1136/bcr-2019-230213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Necrotising autoimmune myopathy (NAM) is an immune-mediated myopathy that may be associated with statin use, malignancy or an autoimmune connective tissue disease, but it can also be idiopathic. Anti-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) myopathy is an extremely rare side effect of statin use, occurring in approximately 2-3 out of every 100 000 patients who use statins. Patients typically present with subacute proximal muscle weakness and creatine kinase levels >10 times the upper limit of normal. The diagnosis is suggested by muscle biopsy showing necrotic fibres with minimal inflammation along with positive anti-HMGCR antibodies. Treatment nearly always requires multiple immunosuppressive agents, the earlier use of which is associated with improved outcomes. Reports of statin-induced NAM leading to heart failure are limited. We present the case of a 69-year-old woman with statin-induced NAM who presented with acute systolic heart failure. Early initiation of high-dose corticosteroids and IVIG resulted in significant improvement in her symptoms.
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