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.