Miopatia imunomediada por anticorpos Anti-HMGCR: revisão da literatura com base num caso clínico

Statins are amongst the most prescribed drugs worldwide and they are generally safe. A rare but potentially serious adverse effect of statins’ therapy has been described – anti-3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (anti-HMGCR) immune-mediated necrotizing myopathy (IMNM) – that can occur years after the drug has been started. We conducted a literature review after illustrating a typical case of anti-HMGCR IMNM. A 67-year-old female treated with simvastatin for the past 5 years presented with proximal myalgias and tetraparesis, raised creatine kinase, a myopathic pattern on electromyogram, a necrotizing myopathy on muscle biopsy and anti-HMGCR antibodies. The statin was stopped, and immunosuppressive therapy was commenced, leading to a complete remission. The distinction between anti-HMGCR IMNM and other myopathies is crucial, so that the appropriate treatment can be started promptly. Likewise, it is important that clinicians be aware of this entity