Rhabdomyolysis as a rare severe complication of statin therapy: differential diagnosis in real clinical practice (a clinical case)

Abstract

The mechanisms of drug-induced myopathies include direct myotoxicity, immune-mediated and indirect muscle damage. Clinical manifestations range from asymptomatic or minor myalgia and muscle weakness to chronic myopathy with severe weakness and, in rare cases, rhabdomyolysis with release of cellular breakdown products into the bloodstream and intercellular space. Although muscle symptoms are the most common adverse events when using statins, they do not pose a real threat in most cases. Rhabdomyolysis is an extremely rare complication of statin therapy. The case illustrates the difficulties that arose in the differential diagnosis of rhabdomyolysis etiology in a patient receiving high-dose statin therapy. The widespread use of high-intensity statin therapy, often accompanied by the simultaneous use of ticagrelor and proton pump inhibitors, requires caution regarding treatment safety, particularly in elderly patients.

Keywords

• lipids
• statins
• high-intensity statin therapy
• statin intolerance
• statin-associated muscle symptoms
• drug induced myopathy
• statin-induced myopathy
• rhabdomyolysis
• acute renal injury