Statin-induced immune mediated necrotising myopathy presenting with a markedly elevated cardiac troponin T in the absence of myocardial injury

Cardiac troponin (cTn) is a sensitive test to assess for myocardial injury. However certain clinical situations can result in a raised cTn in the absence of cardiac involvement. Here we present a case of a 65-year-old woman on long term atorvastatin who presented with generalised weakness, non-specific chest pain, and a persistently elevated high sensitivity cardiac troponin T. Upon further investigation acute myocardial injury was excluded and a diagnosis of statin-induced immune mediated necrotising myopathy (IMNM) was made. The patient improved with cessation of atorvastatin and initiation of immunosuppressive therapy with mycophenolate, intravenous immunoglobulin, and steroids. The mechanism for cTn elevation in skeletal myopathies without cardiac damage and the presentation and treatment of statin-induced IMNM are reviewed. We highlight the importance that in these cases the true cause of the raised cTn is recognised to allow prompt diagnosis and treatment of the underlying myopathy.