An Unusual Case of Statin-Related Myopathy
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 2
Abstract
A 68 year male patient (KB) presented in August 2014 with profound muscle weakness of the hip and legs. Treatment with an 8 cycle regimen of CHOP for NHL 10 years earlier led to complete remission. He had also been treated for BPH with doxazosin, finasteride, and tadalafil. He was otherwise in good health with an eGFR of 77 mL/min. Rosuvastain had maintained lipid levels below targeted values for two years. He was subsequently referred to a neurologist (PZ). Radiological, laboratory, and neuromuscular tests were negative. KB abstained from rosuvastatin beginning in March, 2015. Subjective feelings and objective measures of muscle weakness began improving. Pravastatin 20mg challenge exacerbated weakness, and was stopped. Weakness improved until atorvastatin was initiated in October 2015, but was discontinued after only two doses when leg weakness worsened. The patient has been statin-free since November, 2015. On follow-up on February 10, 2016 muscle strength was objectively normal. In August 2014 KB, a 68 year old Caucasian male (KB) presented at the office of his Internist (CB) for a semi-annual check-up. KB had been diagnosed with Stage 3 mediastinal NHL early in 2004, and had been treated with eight cycles of CHOP that omitted vincristine only in the eighth cycle due to neurological effects that prevented normal hand and finger movement bilaterally. Splenic lesions observed on PET scans led to a splenectomy in 2005, however no malignant cells were found upon biopsy. He remained in complete remission since the conclusion of therapy. He had also been treated medically for BPH for nearly two decades with single daily doses of doxazosin mesylate (8mg) with the addition of finasteride (5mg) beginning about five years ago. Tadalafil (Cialis) 5mg had recently been added for several months as well. Rosuvastatin (20 mg daily) had been taken for hyperlipidemia for several years, successfully keeping all lipid values well below targeted goals, and HDL-cholesterol well above targeted goals. Other medications included fluticsasone proprionate/salmeterol (250mcg/50mcg) once daily and monteleukast (10 mg) daily for chronic, mild asthma, and levothyroxine (88 mcg) daily for hypothyroidism thought to be secondary either to NHL or CHOP treatment. Asthma had been very well controlled with no need for rescue inhalers ever since the initiation of the fluticasone/salmeterol combination and monteleukast. Additionally, KB reported a regular exercise routine of jogging (2 miles, three times weekly) and weight and cardiovascular/weight exercises (P90X™) also three times per week.and monteleukast. Additionally, KB reported a regular exercise routine of jogging (2 miles, three times weekly) and weight and cardiovascular/weight exercises (P90X™) also three times per week. were negative. Thereafter KB was referred to a neurologist (PZ) for further evaluation. KB was first seen by PZ in August 2014. Investigation: During initial evaluation KB recalled a back injury when gardening in November 2013 resulting in reduced flexibility and back pain when bending. Symptoms persisted for months resolving prior to development of leg weakness. There were no issues with bulbar function, sensation, or upper extremity power. There was a question of gait in coordination but no leg muscle atrophy or spasm. Examination revealed normal appearance of limbs and skin without atrophy [4]. Motor examination revealed normal tone and power except for 4/5 hip flexion strength bilaterally. Reflexes were brisk (4/5) without clonus, but with an equivocal left Babinski sign. Sensory function, limb coordination, and gait were normal.
Authors and Affiliations
Kenneth Bachmann, Christopher Bates, Peter Zangara
Keywords
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- EP ID EP567051
- DOI 10.26717/BJSTR.2017.01.000177
- Views 140
- Downloads 0
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