Anti HMGCR myopathy- case presentation and discussion regarding appropriate treatment options

<h3></h3> Statins, or HMG-CoA reductase inhibitors act by decreasing hepatic cholesterol synthesis. Although generally well tolerated, statins may adversely affect skeletal muscle resulting in debilitating muscle weakness with associated rhabdomyolysis and elevated liver enzymes. A rare adverse effect is statin- induced anti-hydroxy-3-methyl-glutaryl-coenzyme A reductase (anti-HMGCR) necrotizing myositis, which may develop after exposure to statins due to autoantibodies against HMG-Co-A reductase. It has been reported without exposure to stains as well due to naturally occurring statins in various foods. Diagnostic tests include electromyography, muscle biopsy, myositis autoantibody panel, and antibodies against the HMGCR. Though there is currently no definitive guidance for the treatment of this condition, corticosteroids are generally considered to be the first line. Here, we present a case of anti-HMGCR-related myopathy associated with atorvastatin. A middle aged lady presented with painful, generalized weakness in all limbs. PMH included HTN, Hypercholesterolaemia on atorvastatin and deranged LFTs. Diagnosis was confirmed by blood test positive for anti-HMG-CoA reductase antibodies. GP discontinued Statin a couple of months before admission due to elevated liver function tests. She was treated with intravenous corticosteroids, with minimal improvement in functional status. We aim to get the medical teams to consider statin-induced necrotizing myositis if a patient has a history of statin use, even if the statin has been discontinued. We also want to highlight the importance of standardised treatment options and considering IVIG in anti HMGC myositis.