Simvastatin-induced mononeuropathy multiplex: case report

Abstract

-The association between the use of statins and neuromuscular disease is currently being intensely discussed.We relate a 63 years old man with possible case of statin-induced neuropathy in a patient with dislipidemia in use of simvastatina at high doses. The electrophysiologic studies disclosed findings compatible with mononeuropathy multiplex, suggested by clinical prescutation of asymmetrical numbness and weakness. More common causes of mononeuropathy multiplex were excluded and the patient improved after the discontinuation of the drug.KEY WORDS: simvastatin, mononeuropathy multiplex, nerve conduction, electromyography.Mononeuropatia múltipla induzida por sinvastatina: relato de caso RESUMO -Polineuropatia induzida por estatina é assunto vigente na literatura médica. Relatamos um possível caso de mononeuropatia múltipla induzida pelo uso de sinvastatina em um homem de 63 anos, em uso de sinvastatina. Após o diagnóstico de dislipidemia, iniciou fraqueza e parestesia assimétrica em membros. O estudo eletromiográfico mostrou alterações compatíveis com mononeuropatia múltipla. As causas mais comuns de mononeuropatia múltipla foram descartadas com a realização de exames complementares pertinentes. O paciente melhorou com a descontinuação da sinvastatina.PALAVRAS-CHAVE: sinvastatina, mononeuropatia múltipla, condução nervosa, eletromiografia.The widespread use of several drugs in the treatment of lipid disorders has led to the reports of many new side effects previously unknown 1 .Among these lipid-lowering drugs, simvastatin is a potent inhibitor of the hidroximetilglutaril coenzyme A (HMG-CoA) redutase, an enzyme acting in the synthesis of cholesterol. The first reports of peripheral neuropathy due to the inhibitors of HMG-CoA redutase were published in 1994 and 1995 2,3 . Phan and coworkers, in 1995, published a series of four patients with peripheral neuropathy caused by simvastatin, with improvement of symptoms after discontinuing the drug 4 . After these initial reports, other series were published 5 , but so far there were no reports of mononeuropathy multiplex due to simvastatin. We present a rare case of mononeuropathy multiplex, clinical and electrophysiologically confirmed, possible induced by simvastatin with improvement of symptoms after the drug was discontinued. CASEA 63 years old man presented with a history of pain in the posterior right thigh that started three weeks prior to his admission. He also developed in a few days paresthesias in his fingers and toes bilaterally, distal weakness in his hands and difficulty to walk. He denied taking alcohol, using illicit drugs or handling chemical substances. He had been taking simvastatin 40 mg a day for the past six months for the treatment of hypercholesterolemia, with an increase in the dosage to 80 mg in the past month due to misinterpretation of his prescription. He also denied taking any other medications or having other systemic symptoms like fever, anorexia or weight loss. Physical examination was normal and on neurological examination he...

Simvastatin-Induced Meralgia Paresthetica

“…12,14,15 A case of mononeuropathy multiplex and a case of a disorder resembling GuillainBarré also have been described both after simvastatin use. 16,17 A partial explanation for nerve damage by statins is their inhibition not only of cholesterol synthesis but also of dolichol and ubiquinone; the latter is a key enzyme in the respiratory mitochondrial chain. An intracellular deficiency of ubiquinone has the potential to affect neurons' energy utilization.…”

Estatinas y patología neuromuscular

“…Se han descrito casos de mononeuritis múltiples [32,33], polineuropatía, polineuritis y polirradiculopatía. El perfil típico es de casos de instauración insidiosa, evolución crónica, clínica sensitiva y de predominio distal; sin embargo, se han descrito casos de neuropatía aguda o subaguda, dolorosa, o afectación predominantemente autonómica [34] o motora [28].…”