Deep venous thrombosis in an individual with statin-exposed anti-SRP myopathy: case report and review of literature

Abstract Background Immune-mediated necrotizing myopathy (IMNM) is characterized by proximal muscle weakness, elvated serum muscle enzyme levels, myopathic electromyography findings, and necrotic muscle fiber with few inflammatory cell infiltration in muscle biopsies. Statins, the first line drug to...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Jiali Li, Mingming Yan, Jiao Qin, Lingyan He, Cao Dai, Rui Wen
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Immune-mediated necrotizing myopathy Anti-signal recognition particle myopathy Deep venous thrombosis Statins Diseases of the blood and blood-forming organs RC633-647.5
Acceso en línea:	https://doaj.org/article/084ae4e75beb4cbf81cdb3bc27b0edcf
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:084ae4e75beb4cbf81cdb3bc27b0edcf
record_format	dspace
spelling	oai:doaj.org-article:084ae4e75beb4cbf81cdb3bc27b0edcf2021-11-28T12:25:28ZDeep venous thrombosis in an individual with statin-exposed anti-SRP myopathy: case report and review of literature10.1186/s12959-021-00347-x1477-9560https://doaj.org/article/084ae4e75beb4cbf81cdb3bc27b0edcf2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12959-021-00347-xhttps://doaj.org/toc/1477-9560Abstract Background Immune-mediated necrotizing myopathy (IMNM) is characterized by proximal muscle weakness, elvated serum muscle enzyme levels, myopathic electromyography findings, and necrotic muscle fiber with few inflammatory cell infiltration in muscle biopsies. Statins, the first line drug to lower triglyceride and cholesterol level in blood, have been reported to be associated with statins-induced necrotizing autoimmune myopathy (SINAM). Although anti-3-hydroxy-3-methylglutarylcoenzyme-A reductase (anti-HMGCR) myopathy is considered as the leading myopathy related to the statins medication, anti-signal recognition particle (SRP) myopathy were also identified in several cases with statin exposure. The risk of deep venous thrombosis (DVT) is substantially high in individuals with autoimmune inflammatory diseases. But few studies have reported the occurrence and recommendation for treatment of DVT in patients with anti-SRP myopathy. Here, we reported a statin-exposed anti-SRP myopathy individual developed DVT who was successfully treated with catheter-directed thrombolysis (CDT) and systemic anticoagulants therapy. Case presentation A 56-year-old Chinese female came to the outpatient room with gradually progressive bilateral lower-extremity weakness. Magnetic resonance imaging revealed myopathy in bilateral thighs. Serum anti-SRP antibody was positive. She was diagnosed with anti-SRP myopathy. When treated with corticosteroids and immunosuppressants, the patient developed mild edema and pain of left lower extremity. Angiography and ultrasound revealed diffuse venous thrombosis of left lower extremity. Therapy was initiated with CDT and lower molecular weight heparin, then switched to once daily oral rivaroxaban. Meanwhile, steroids combined with tacrolimus were also carried on while simvastatin was discontinued. One month later, patient’s symptoms were resolved and only partial thrombosis in left femoral vein was remained. Conclusion The prevalence of DVT in patient with anti-SRP myopathy was rare. No well-established treatment strategy is available to manage the IMNM and DVT at the same time. The systemic anticoagulants therapy combined CDT can be an effective therapeutic approach to address extensive DVT in patient with anti-SRP myopathy.Jiali LiMingming YanJiao QinLingyan HeCao DaiRui WenBMCarticleImmune-mediated necrotizing myopathyAnti-signal recognition particle myopathyDeep venous thrombosisStatinsDiseases of the blood and blood-forming organsRC633-647.5ENThrombosis Journal, Vol 19, Iss 1, Pp 1-4 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Immune-mediated necrotizing myopathy Anti-signal recognition particle myopathy Deep venous thrombosis Statins Diseases of the blood and blood-forming organs RC633-647.5
spellingShingle	Immune-mediated necrotizing myopathy Anti-signal recognition particle myopathy Deep venous thrombosis Statins Diseases of the blood and blood-forming organs RC633-647.5 Jiali Li Mingming Yan Jiao Qin Lingyan He Cao Dai Rui Wen Deep venous thrombosis in an individual with statin-exposed anti-SRP myopathy: case report and review of literature
description	Abstract Background Immune-mediated necrotizing myopathy (IMNM) is characterized by proximal muscle weakness, elvated serum muscle enzyme levels, myopathic electromyography findings, and necrotic muscle fiber with few inflammatory cell infiltration in muscle biopsies. Statins, the first line drug to lower triglyceride and cholesterol level in blood, have been reported to be associated with statins-induced necrotizing autoimmune myopathy (SINAM). Although anti-3-hydroxy-3-methylglutarylcoenzyme-A reductase (anti-HMGCR) myopathy is considered as the leading myopathy related to the statins medication, anti-signal recognition particle (SRP) myopathy were also identified in several cases with statin exposure. The risk of deep venous thrombosis (DVT) is substantially high in individuals with autoimmune inflammatory diseases. But few studies have reported the occurrence and recommendation for treatment of DVT in patients with anti-SRP myopathy. Here, we reported a statin-exposed anti-SRP myopathy individual developed DVT who was successfully treated with catheter-directed thrombolysis (CDT) and systemic anticoagulants therapy. Case presentation A 56-year-old Chinese female came to the outpatient room with gradually progressive bilateral lower-extremity weakness. Magnetic resonance imaging revealed myopathy in bilateral thighs. Serum anti-SRP antibody was positive. She was diagnosed with anti-SRP myopathy. When treated with corticosteroids and immunosuppressants, the patient developed mild edema and pain of left lower extremity. Angiography and ultrasound revealed diffuse venous thrombosis of left lower extremity. Therapy was initiated with CDT and lower molecular weight heparin, then switched to once daily oral rivaroxaban. Meanwhile, steroids combined with tacrolimus were also carried on while simvastatin was discontinued. One month later, patient’s symptoms were resolved and only partial thrombosis in left femoral vein was remained. Conclusion The prevalence of DVT in patient with anti-SRP myopathy was rare. No well-established treatment strategy is available to manage the IMNM and DVT at the same time. The systemic anticoagulants therapy combined CDT can be an effective therapeutic approach to address extensive DVT in patient with anti-SRP myopathy.
format	article
author	Jiali Li Mingming Yan Jiao Qin Lingyan He Cao Dai Rui Wen
author_facet	Jiali Li Mingming Yan Jiao Qin Lingyan He Cao Dai Rui Wen
author_sort	Jiali Li
title	Deep venous thrombosis in an individual with statin-exposed anti-SRP myopathy: case report and review of literature
title_short	Deep venous thrombosis in an individual with statin-exposed anti-SRP myopathy: case report and review of literature
title_full	Deep venous thrombosis in an individual with statin-exposed anti-SRP myopathy: case report and review of literature
title_fullStr	Deep venous thrombosis in an individual with statin-exposed anti-SRP myopathy: case report and review of literature
title_full_unstemmed	Deep venous thrombosis in an individual with statin-exposed anti-SRP myopathy: case report and review of literature
title_sort	deep venous thrombosis in an individual with statin-exposed anti-srp myopathy: case report and review of literature
publisher	BMC
publishDate	2021
url	https://doaj.org/article/084ae4e75beb4cbf81cdb3bc27b0edcf
work_keys_str_mv	AT jialili deepvenousthrombosisinanindividualwithstatinexposedantisrpmyopathycasereportandreviewofliterature AT mingmingyan deepvenousthrombosisinanindividualwithstatinexposedantisrpmyopathycasereportandreviewofliterature AT jiaoqin deepvenousthrombosisinanindividualwithstatinexposedantisrpmyopathycasereportandreviewofliterature AT lingyanhe deepvenousthrombosisinanindividualwithstatinexposedantisrpmyopathycasereportandreviewofliterature AT caodai deepvenousthrombosisinanindividualwithstatinexposedantisrpmyopathycasereportandreviewofliterature AT ruiwen deepvenousthrombosisinanindividualwithstatinexposedantisrpmyopathycasereportandreviewofliterature
_version_	1718407935098355712

Deep venous thrombosis in an individual with statin-exposed anti-SRP myopathy: case report and review of literature

Ejemplares similares