Hepatitis, rhabdomyolysis and multi-organ failure resulting from statin use

This paper was published in the British Medical Journal Case Reports 2009;2009. pii: bcr07.2008.0412

Study title and authors:
Hepatitis, rhabdomyolysis and multi-organ failure resulting from statin use.

Rajaram M.
St Helens and Knowsley Hospitals NHS Trust, Medicine-Gastro, Whiston Hospital, Warrington Prescot, L35 5DR, UK.

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/21686823

This paper reports the case of of a woman who developed hepatitis, rhabdomyolysis and multi-organ failure resulting from the use of statins.

(i) A 77-year-old female patient was admitted to hospital with malaise, anorexia and generally feeling unwell for a week.
(ii) She was taking atorvastatin 80 mg daily.
(iii) The dose of atorvastatin was increased from 40 mg to 80 mg daily approximately six months before admission.
(iv) Examination revealed she was jaundiced.
(v) Laboratory tests revealed the following abnormalities (normal levels in brackets):
Creatine kinase: 523 iu/l (25–200)
Lactate dehydrogenase: 1241 iu/l (240–525)
Total bilirubin: 284 μmol/l (2–22)
Alanine transaminase: 2314 iu/l (11–55)
γ glutamyl transferase: 132 iu/l (5–50)
Aspartate transaminase: 1269 iu/l (12–42)
Alkaline phosphatase: 438 iu/l (40–125)
Urea: 15.9 mmol/l (3.6–7.3)
Creatinine: 290μmol/l (45–110)
(vi) A diagnosis of hepatitis related to statin use with accompanying kidney failure was made.
(vii) The statin was stopped and her liver biochemistry improved.
(viii) However on the fourth day after admission, her kidney function deteriorated.
(ix) Examination revealed excess fluid around the lungs and abdominal areas.
(x) The patient was transferred to the intensive care unit and required haemofiltration. (Hemofiltration is a kidney replacement therapy similar to hemodialysis).
(xi) Despite improvement in her kidney function, the creatine kinase levels continued to rise and peaked at 107178 iu/l.
(xii) Two weeks after admission to the hospital, the patient died of multi-organ failure.

Rajaram concludes: "The cause of hepatitis, rhabdomyolysis, and acute renal failure in this patient was the increase in dose of atorvastatin and subsequent elevation of serum atorvastatin concentration. We suggest that the elevation of atorvastatin concentrations resulted in skeletal muscle damage and rhabdomyolysis, as indicated by the elevation of creatine kinase and subsequent deposition of myoglobin in the kidneys, causing acute renal failure as indicated by the elevation of urea and creatinine".

From a fish tank injury to hospital haemodialysis: the serious consequences of statin drug interactions

This paper was published in BMJ Case Reports 2015 Jun 23;2015

 

Study title and authors:

From a fish tank injury to hospital haemodialysis: the serious consequences of drug interactions.

Hill FJ, McCloskey SJ, Sheerin N.

Renal Department, Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne, UK.

 

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/26106178

This paper describes the case of a man who suffered acute kidney injury following statin-induced rhabdomyolysis.

(i) A 68-year-old man was admitted to hospital with severe acute kidney injury secondary to statin-induced rhabdomyolysis.
(ii) Five weeks previously, the patient started a course of clarithromycin for infection of a finger wound. His current medications included simvastatin, which he continued along with clarithromycin.
(iii) The severity of the acute kidney injury necessitated initial continuous venovenous haemofiltration followed by 12 haemodialysis sessions before a spontaneous improvement in renal function occurred.

Hill concluded: "Statins are widely prescribed and we report this case to encourage increased vigilance in avoiding drug interactions known to increase the risk of statin-induced myopathy, including macrolide antibiotics, calcium channel antagonists and amiodarone".

Rhabdomyolysis occurring under statins after intense physical activity in a marathon runner

This paper was published in Case Reports in Rheumatology 2015;2015:721078

Study title and authors:
Rhabdomyolysis Occurring under Statins after Intense Physical Activity in a Marathon Runner.

Toussirot É, Michel F, Meneveau N.
Clinical Investigation Center for Biotherapy, CIC-1431, FHU INCREASE, University Hospital of Besançon, 25000 Besançon, France

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/25815236

This paper reports the case of a marathon runner who developed rhabdomyolysis.

(i) A 50 year old man healthy man started to take atorvastatin but soon suffered from severe muscle pain. He then was prescribed rosuvastatin.
(ii) The patient was a regular long-distance and marathon runner. He was preparing for an international competition.
(iii) On the day of the competition and while being still under rosuvastatin, the patient experienced progressively worsening muscular weakness. At the end of the race, he suffered from severe pains in the lower limbs similar to diffuse cramps associated with generalized muscle contraction.
(iv) Muscle enzymes (creatine kinase) were tested two days after the race and were at 2631 IU/L (normal levels 300) and he was diagnosed with rhabdomyolysis.
(v) One year later, (without taking the statins), for another marathon, the patient felt no muscle weakness at all or muscle contractions after the race.

Toussirot concluded: "Intense physical activity, as performed by statin treated athletes (whether professional or not and particularly during long-distance races) could have adverse consequences on muscles".

Statins with pomegranate juice may increase the risk of rhabdomyolysis

This study was published in the American Journal of Cardiology 2006 Sep 1;98(5):705-6

Study title and authors:
Rhabdomyolysis associated with pomegranate juice consumption.

Sorokin AV, Duncan B, Panetta R, Thompson PD.
Section of Preventive Cardiology, Division of Cardiology, Henry Low Heart Center, Hartford Hospital, Hartford, Connecticut, USA.

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/16923466

This paper reports the case of a man who developed rhabdomyolysis after drinking pomegranate juice while taking statins.

(i) A 48-year-old man had been taking ezetimibe and rosuvastatin for 17 months.
(ii) Three weeks before admission to hospital, he began drinking pomegranate juice (200 ml twice weekly).
(iii) On admission he had thigh pain and elevated serum creatine kinase level (138,030 U/L, normal is less than 200 U/L) and was diagnosed with rhabdomyolysis.

Sorokin concludes: "This report suggests that pomegranate juice may increase the risk of rhabdomyolysis during rosuvastatin treatment".