Introduction:
Statins significantly reduce the risk of cardiovascular disease and are
generally considered safe. On rare occasions, statins can cause muscle
disease, and most of these cases recover on discontinuation of the
statin. Even more infrequently, statins can cause statin-associated
necrotizing autoimmune myositis (SANAM) that is characterized by muscle
necrosis on biopsy in the presence of antibodies to
3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. These
patients need to be treated with aggressive immunosuppressive therapy,
but the treatment response is often poor with a variable clinical
response. With the development of newer therapies for dyslipidemia, the
prevalence of SANAM as a disease entity will decrease, making it even
harder to diagnose and treat. We present a typical case of SANAM with a
poor response to aggressive therapy.