The patient, age 82, had recovered from a stroke several months ago. According to a recent article reported on dnyuz.com and originally published in the New York Times, the recovery was short-lived. He began to have difficulty swallowing food as well as liquids. His weight had dropped significantly. Finally, in desperation, they called an otolaryngologist (treats ears, nose, or throat) who informed the couple that he did not find a blockage. He urged the couple to request therapy and meanwhile thicken liquids for easier swallowing.
The patient’s wife explained that the past few months had been terrifying as her husband gagged on each bite of food or sip of liquid. Thickening liquids only exacerbated the problem.
Although the stroke affected his right side somewhat, his condition deteriorated to the extent that he had to rely on his wife to help him stand or sit. He had lost almost forty pounds.
The couple placed an urgent call to his primary care physician, Richard Kaufmann, M.D.
Dr. Kaufman had previously ordered blood tests. Upon analyzing the results of the test, he urged the couple to go to the hospital immediately. He had determined that the patient’s kidneys were not functioning.
About The Test Results
Osama Kandalaft, M.D. was on Emergency Room duty when the couple arrived in December 2021. The staff was doing their best to attend to the tremendous influx of COVID-19 cases. Initially, the only available accommodation was a gurney in the hall.
Dr. Kandalaft analyzed the test results and found the patient’s kidneys to be in extremely poor condition. Fortunately, Dr. Kandalaft recognized a pattern that he had seen in other labs.
One of the tests showed blood in the patient’s urine. However, upon a closer examination of the urine itself, blood was not found.
The “blood” showing in the initial test was in fact myoglobin, a subunit of hemoglobin. It transports and carries oxygen in muscle cells. After an injury, it is released into the bloodstream.
In addition to muscle damage, the patient had been taking a statin medication (rosuvastatin) that lowers cholesterol, but has the potential to cause damage to muscles.
Dr. Kandalaft ordered the patient to stop taking rosuvastatin while he ordered another test looking for creatine kinase which is also released when muscles are injured.
The couple was not able to leave the ER until dawn the next day when a bed became available for a non-COVID patient. It was then that Andrew Sanchez, M.D. introduced himself as his attending physician. Dr. Sanchez explained that the test results indicated his muscle injury was almost forty times more severe than normal.
Dr. Sanchez had two muscle disorders in mind as possibilities. One was Lambert-Eaton myasthenic syndrome (LEMS) and the other was polymyositis. Dr. Sanchez was able to rule out LEMS because there was no direct correlation between the LEMS symptoms and the patient’s condition.
Polymyositis seemed a more likely match as it is an autoimmune disease whereby the immune system goes on the attack against the patient’s muscles.
Dr. Sanchez ordered another test for a disorder caused by statins. It is called statin-associated immune-mediated necrotizing myopathy.
Since test results and final diagnosis would not be immediately available, the patient had to temporarily receive nourishment through a feeding tube.
Meanwhile, Dr. Sanchez reasoned that if the patient’s problems were due to an immune response, it would be beneficial to administer steroid treatment. By treating the patient with steroids, the destructive immune response would be suppressed and the muscles could be repaired.
Process of Elimination
Initial test results ruled out LEMS and polymyositis. At the same time, the patient began to feel stronger, believing his new strength was due to the steroids.
Finally, the results of the last test identified an antibody that was triggered by a immune-mediated necrotizing myopathy. Each of the patient’s symptoms was the result of the cholesterol-lowering drug he had been prescribed.
Highly Recommended
Statins have many well-known benefits such as reducing the number of strokes and heart attacks. They are also well tolerated.
Statins are among the country’s most heavily prescribed medications in the U.S. Yet it has been known for decades that statins may cause serious injury. The statin-induced disorder described above was reported as early as 1994, yet the mechanism remains unknown.
The disorder is rare, affecting two people among every million individuals. The damage continues even when the patient discontinues the medication. Steroids or other types of medication that suppresses the immune system are the standard treatment.
In Conclusion
The patient has taken months to recover and is able to walk with the aid of a walker. His ability to eat has returned. So far he has opted for retirement. However, his wife believes that if he continues to improve at this rate, he may eventually return to work.
