Autoimmune necrotizing myopathy in an octogenarian: a case report

C. Quarracino, N. Pérez, P.J. Landi, L. Paz, G. Gómez, P. Santoro

Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Argentina

Autoimmune necrotizing myopathy (ANM) is a rare form of immune-mediated myopathy, with less than 200 cases reported worldwide. Its mean age of presentation is of 64 years and only 8 cases of octogenarians have been described so far. We present the case of NAM in an 82 year-old male patient who consulted with a 3-month painless subacute proximal upper and lower limb weakness that led him to prostration. He had been taking statins for two years as secondary stroke prevention. His work-up showed high CK levels, a pathological EMG and a muscular biopsy compatible with necrotizing myopathy. ANM is an infrequent pathology that has statin use as a known risk factor. In turn, statin prescription has been significantly boosted by the 2013 American Heart Association’s cholesterol treatment guidelines. Unlike younger patients, a mild motor morbidity in older people can significantly worsen their risk of falls, which is consecutively associated with functional decline, hospitalization and death. We estimate that given the worldwide population ageing and the statinization process currently ongoing, geriatric cases will increase in frequency and we believe that due to their extreme frailty statin indication and close follow-up should be mindfully considered in octogenarians. 

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