Statin-Induced Necrotizing Autoimmune Myopathy: Case Report of a Patient under Chronic Treatment

Figure 1

MRI of skeletal muscle. The figure shows four MRI axial views of pelvic girdle muscle acquired before (a, b) and after (c, d) therapy. The images are T2-weighted sequences with chemical-shift fat saturation obtained at the level of greater sciatic foramen (a) and (c) and at the level of ischial tuberosity (b) and (d). In (a), mild hyperintensity of signal within the muscles gluteus minimun and medium (arrowhead) on the left side can be observed, and it is related to intramuscular edema. After therapy, the edema is significantly reduced (arrowhead in (c)). Similarly, in the more caudal scan, the edema related to the inflammatory process can be appreciated in the left obturator externus, adductor magnus muscles (arrow in (b)) and left gluteus maximum muscle (void arrowhead in (b)). After therapy, the intramuscular edema of obturator externus and adductor magnus is less evident (arrow in (d)) while it is completely resolved in the gluteus maximus (void arrowhead in (d)). The muscle pathologic signal alterations are bilateral but on the right side they result more faint, keeping with the patchy and asymmetrical muscular involvement of the statin-induce myonecrosis.

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