Statin-induced Necrotizing Autoimmune Myopathy
Statin-induced Necrotizing Autoimmune Myopathy
复制标题
他汀类药物诱发的坏死性自身免疫性肌病
DOI：
10.14735/amcsnn2017569
复制
发表时间：
2017
影响因子：
0.5
通讯作者：
J. Bednařík
中科院分区：
文献类型：
--
作者：
Tomáš Horák;S. Voháňka;E. Tvrdíková;Magda Horáková;J. Bednařík
一名 76 岁男性，既往有两次中风病史，并发残余轻度认知障碍、心房颤动、冠状动脉疾病、2 型糖尿病、充血性心力衰竭、血脂异常和 3 期慢性肾病，因发育迟缓和功能衰退而入院。两个月前，他因疲劳和无法行走而短暂住院。当时，他被发现脱水并接受尿路感染治疗。他的身体虚弱是由于过度劳累和最近旅行导致的疲惫，随后他被转移到专业护理机构进行康复。住院之前，他一直能够独立行走并积极工作。经过一个月的康复治疗后，他能够借助助行器行走，但他的日常生活活动 (ADL) 需要帮助。回家后，尽管进行了家庭物理治疗，但他的功能逐渐下降。他患有腹泻、体重减轻和吞咽困难，导致进食时误吸。他被送进医院，发现身体虚弱且营养不良。他被发现患有肝脏转氨炎，肌酐激酶 (CK) 水平升高至 3095 U/L（参考号 63-473 U/L）。改良的吞钡研究 (MBSS) 表明口咽吞咽阶段效率低下，舌头收缩减少，咳嗽微弱且无效。建议不要给他口服任何东西（NPO）。患者随后发生误吸并被转移到 ICU，在那里接受高流量鼻氧支持，并接受静脉注射抗生素治疗吸入性肺炎。进行了风湿病学和神经病学咨询，两位咨询师都担心炎症或坏死性肌炎。患者拒绝接受建议的检查，包括大脑和股骨的 MRI 以及肌肉活检。由于患者疲劳，无法进行 EMG/NCS。由于缺乏支持坏死性肌病诊断的客观数据，因此未开始使用免疫抑制剂进行经验性治疗。患者呼吸状态稳定，于住院第 6 天转出 ICU。住院第 9 天放置经皮内窥镜胃造口管。住院第 11 天，患者再次发生缺氧误吸事件，其表现与之前中风的表现一致。他的呼吸状况仍然很脆弱，患者决定不需要积极治疗或进一步检查。在住院第 13 天，他去世了。在他去世后，实验室检测 HMG-CoA 还原酶抗体结果显着升高，>200 U（参考值 0-19 U）。讨论
A 76-year-old man with a history of two prior strokes complicated by residual mild cognitive impairment, atrial fibrillation, coronary artery disease, diabetes mellitus type 2, congestive heart failure, dyslipidemia, and stage 3 chronic kidney disease was admitted for failure to thrive and functional decline. Two months prior, he had been briefly hospitalized for fatigue and inability to walk. At that time, he was found to be dehydrated and was treated for a UTI. His weakness was attributed to exhaustion from overwork and recent travel, and he was subsequently transferred to a skilled nursing facility for rehabilitation. Prior to that hospitalization he had been walking independently and actively working. After a month of rehabilitation therapy, he was able to ambulate with a walker, but he required assistance with his activities of daily living (ADLs). Upon his return home, his function progressively declined despite home physical therapy. He suffered from diarrhea, weight loss, and swallowing difficulties resulting in aspiration with food intake. He was admitted to the hospital and noted to be frail and malnourished. He was found to have liver transaminitis and an elevated creatinine kinase (CK) level of 3095 U/L (reference 63-473 U/L). A modified barium swallow study (MBSS) demonstrated an inefficient oropharyngeal swallow phase with reduced based of tongue contraction and a weak and ineffective cough. It was recommended to give him nothing by mouth (NPO). The patient subsequently aspirated and was transferred to the ICU, where he was supported with high flow nasal O2 support and was treated with intravenous antibiotics for aspiration pneumonia. Rheumatology and neurology consults were obtained, and both consultants were concerned for an inflammatory or necrotizing myositis. The patient declined components of the recommended work-up including an MRI of the brain and femur and a muscle biopsy. An EMG/NCS could not be performed due to patient fatigue. Because of the lack of objective data to support a diagnosis of necrotizing myopathy, empiric treatment with immunosuppressive agents was not initiated. The patient’s respiratory status stabilized, and he was transferred out of the ICU on hospital day 6. A percutaneous endoscopic gastrostomy tube was placed on hospital day 9. On his 11th hospital day, the patient suffered another hypoxic aspiration event and manifested findings consistent with a re-expression of his previous stroke. His respiratory status remained tenuous, and the patient decided that he did not want aggressive treatment or further testing. On his 13th hospital day, he expired. After his death, lab testing for antibody to HMG-CoA reductase result came back significantly elevated, >200 U (reference 0-19 U). Discussion
DOI：
10.1001/jama.2015.13766
发表时间：
2015-11-03
期刊：
JAMA
影响因子：
--
作者：
Kantor ED;Rehm CD;Haas JS;Chan AT;Giovannucci EL
通讯作者：
Giovannucci EL
DOI：
10.1111/jch.13797
发表时间：
2020
期刊：
Journal of clinical hypertension (Greenwich, Conn.)
影响因子：
--
作者：
Whelton,PaulK;Campbell,NormRC;Lackland,DanielT;Parati,Gianfranco;Ram,CVenkataS;Weber,MichaelA;Zhang,Xin-Hua
通讯作者：
Zhang,Xin-Hua
影响因子：
--
作者：
Christopher-Stine, Lisa;Casciola-Rosen, Livia A.;Hong, Grace;Chung, Tae;Corse, Andrea M.;Mammen, Andrew L.
通讯作者：
Mammen, Andrew L.