Thiriveedi M, Patel H, Reddy PJ. Refractory rosuvastatin-associated necrotizing autoimmune myopathy: A case report and review of literature. World J Clin Cases 2026; 14(14): 120126 [DOI: 10.12998/wjcc.v14.i14.120126]
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Mrudula Thiriveedi, MD, Chief Physician, Department of Internal Medicine, Decatur Morgan Hospital, 1201 7th Street SE, Decatur, AL 35601, United States. drmrudula.giridhar@gmail.com
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Case Report
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May 16, 2026 (publication date) through Apr 27, 2026
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World Journal of Clinical Cases
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Thiriveedi M, Patel H, Reddy PJ. Refractory rosuvastatin-associated necrotizing autoimmune myopathy: A case report and review of literature. World J Clin Cases 2026; 14(14): 120126 [DOI: 10.12998/wjcc.v14.i14.120126]
World J Clin Cases. May 16, 2026; 14(14): 120126 Published online May 16, 2026. doi: 10.12998/wjcc.v14.i14.120126
Refractory rosuvastatin-associated necrotizing autoimmune myopathy: A case report and review of literature
Mrudula Thiriveedi, Hersh Patel, Punuru J Reddy
Mrudula Thiriveedi, Punuru J Reddy, Department of Internal Medicine, Decatur Morgan Hospital, Decatur, AL 35601, United States
Hersh Patel, Department of Medicine, Alabama College of Osteopathic Medicine, Dothan, AL 36303, United States
Author contributions: Thiriveedi M and Patel H contributed to manuscript writing, editing, and data collection; Reddy P and Thiriveedi M contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient’s son (next of kin) for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Mrudula Thiriveedi, MD, Chief Physician, Department of Internal Medicine, Decatur Morgan Hospital, 1201 7th Street SE, Decatur, AL 35601, United States. drmrudula.giridhar@gmail.com
Received: February 24, 2026 Revised: March 10, 2026 Accepted: April 2, 2026 Published online: May 16, 2026 Processing time: 67 Days and 10.6 Hours
Abstract
BACKGROUND
Statin-associated necrotizing autoimmune myopathy (NAM) is an immune-mediated myopathy characterized by progressive weakness, markedly elevated creatine kinase (CK), and antibodies to 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR). Unlike toxic statin myopathy, symptoms and CK elevation persist despite statin discontinuation and typically require immunosuppressive therapy. Although many patients improve with corticosteroids and intravenous immunoglobulin (IVIG), severe or refractory cases can occur with any statin exposure. We report a case of rosuvastatin-associated NAM complicated by persistent rhabdomyolysis and renal failure despite multimodal immunotherapy.
CASE SUMMARY
An 83-year-old woman with a history of bladder, breast, and lung cancers, coronary artery disease, stage 3b chronic kidney disease, and hyperlipidemia on rosuvastatin presented with progressive weakness, fatigue, and a fall with prolonged immobilization for approximately ten hours. Examination showed diffuse weakness without focal neurologic deficits. Laboratory testing revealed severe rhabdomyolysis (CK 9012 U/L), anemia (hemoglobin 8.1 g/dL), and acute kidney injury (creatinine 4.0 mg/dL). She was treated with intravenous (IV) fluids, bicarbonate infusion, and hemodialysis. Despite statin discontinuation, CK remained persistently elevated (4000-7000 U/L) with worsening myalgias and functional decline. Anti-HMGCR antibody titers returned markedly elevated (348.8 CU), and other myositis serologies were negative. High-dose IV methylprednisolone, IVIG, and rituximab were administered without clinical or biochemical improvement. Her hospital course was complicated by dialysis dependence, refractory pain, and malnutrition. Following goals-of-care discussions, dialysis was withdrawn, and the patient died on hospital day 32.
CONCLUSION
Persistent CK elevation after statin withdrawal warrants anti-HMGCR antibody testing and early immunosuppression. Delayed recognition may lead to disability or death.
Core Tip: Statin-associated necrotizing autoimmune myopathy (NAM) is a rare immune-mediated myopathy defined by progressive weakness, marked creatine kinase elevation, and persistence of disease activity despite statin withdrawal, most often associated with anti-3-hydroxy-3-methylglutaryl–coenzyme A reductase antibodies. Many patients respond to corticosteroids and intravenous immunoglobulin (IVIG), but refractory disease can occur, particularly when diagnosis is delayed or when severe systemic complications develop. We report an elderly woman receiving long-term rosuvastatin who developed persistent rhabdomyolysis with dialysis-dependent renal failure and died despite high-dose corticosteroids, IVIG, and rituximab. This case underscores the need for early antibody testing and prompt escalation of therapy when statin-associated NAM is suspected, to prevent severe outcomes.
