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

BMJ Case Rep. 2020 Feb 5;13(2):e232391. doi: 10.1136/bcr-2019-232391.


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.

Keywords: liver disease; muscle disease; rheumatology; unwanted effects / adverse reactions.

Publication types

  • Case Reports

MeSH terms

  • Autoimmune Diseases / chemically induced
  • Autoimmune Diseases / diagnosis*
  • Deglutition Disorders / etiology*
  • Hepatitis, Autoimmune / complications
  • Hepatitis, Autoimmune / diagnosis*
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects*
  • Male
  • Middle Aged
  • Myositis / chemically induced
  • Myositis / diagnosis*


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors