Abstract
BACKGROUND: IBM is the most common inflammatory myopathy in individuals older than age 50. Statins are commonly prescribed in this age group. Statins may induce a variety of muscle related syndromes including HMG CoA reductase antibody myopathy. OBJECTIVE: To report a rare case with both IBM and HMG CoA reductase antibody myopathy. METHODS: Case report and literature pertinent to IBM and HMG CoA reductase antibody myopathy was reviewed. CASE: An 80 year-old African American man with a history of hypertension, mild diabetes, dyslipidemia on atorvastatin 80 mg daily for two years, and a prior right middle cerebral artery infarct without any residual neurological deficits was admitted for acute worsening of a slowly progressive quadriparesis and dysphagia over 2-3 years. On examination, he was not ambulatory with marked symmetrical proximal arm and leg weakness. Labs including CBC, CMP, ANA, ESR, CRP, and TSH were normal. Serum creatine kinase was 6,500. Electromyography showed increased fibrillations and short, small motor unit action potentials in multiple muscle groups suggestive of an inflammatory or necrotizing myopathy. Left tibialis anterior biopsy showed inclusion bodies suggestive of IBM along with myofibular necrosis and mild inflammatory cells suggestive of necrotizing myopathy. Anti-HMG CoA reductase antibody level was markedly elevated. He was treated with intravenous immunoglobulin. His strength improved; he now ambulates with a walker and takes care of his activities of daily living, but continues to be on tube feeds. Our patient had chronic progressive weakness due to IBM and acute worsening was presumably due to statin-induced autoimmune myopathy. CONCLUSION: In patients with IBM and abrupt worsening, secondary causes of myopathy should be considered. In patients with a history of statin exposure, HMG CoA reductase antibody myopathy should be included in the evaluation as it is potentially treatable with immune therapy.
Disclosure: Dr. Kulhari has nothing to disclose. Dr. Preston has nothing to disclose.
Monday, April 18 2016, 8:30 am-7:00 pm
- Copyright © 2016 by AAN Enterprises, Inc.
Disputes & Debates: Rapid online correspondence
NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.
- Stay timely. Submit only on articles published within the last 8 weeks.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- 200 words maximum.
- 5 references maximum. Reference 1 must be the article on which you are commenting.
- 5 authors maximum. Exception: replies can include all original authors of the article.
- Submitted comments are subject to editing and editor review prior to posting.