Statin-induced necrotising autoimmune myopathy and autoimmune hepatitis presenting with dysphagia

Agha, Osama Qasim
Kaur, Sukhdeep
Vijayavel, Nirmal

¹ Department of Internal Medicine, St. Jospeh's Hospital and Medical Center, Phoenix, Arizona, USA
² Department of Internal Medicine, Creighton University School of Medicine, Phoenix, Arizona, USA
³ Creighton University School of Medicine, Phoenix, Arizona, USA

Correspondence to Dr Osama Qasim Agha; [email protected]

Accepted January 14, 2020.

Contributors All authors substantially contributed to the design of the case, revised it critically, approved the final draft and agreed to be accountable for all aspects of the work. NV wrote the initial case presentation and investigation parts. He reviewed the grammar and he was part of reviewing and editing the last version of the article. OQA and SK wrote and edited the summary, background, differential diagnosis, treatment, follow-up, discussion, learning points and references. They also reviewed and edited the case presentation and investigation parts. They reviewed the entire case and made editions on the last version of the article. Please note that SK and OQA contributed equally to this paper.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent for publication Obtained.

Provenance and peer review Not commissioned; externally peer reviewed.

BMJ Case Reports 13(2):p e232391, February 2020. | DOI: 10.1136/bcr-2019-232391

SUMMARY

Statin-induced necrotising autoimmune myopathy (SINAM) is a rare disease characterised by proximal muscle weakness and elevated creatine kinase levels that is usually in the thousands. Anti-3-hydroxy-3-methyl glutaryl co-enzyme A reductase (HMGCR) antibodies are associated with SINAM. Autoimmune hepatitis (AIH) is an inflammatory disease of the liver that is usually of unknown aetiology but can also be associated with concurrent extrahepatic autoimmune disorders. We are reporting a case of biopsy proven AIH associated with SINAM in a patient presenting with oropharyngeal dysphagia. The patient had elevated anti-HMGCR antibodies and anti-smooth muscle antibodies. SINAM and AIH were confirmed by muscle biopsy and liver biopsy, respectively. The patient had complete resolution of his symptoms and complete normalisation of his liver function tests after 6 months of the treatment.