Delayed-Onset Rhabdomyolysis of Bilateral Lower Extremities Following Statin Therapy in a 63-Year-Old Woman: A Case Report

BACKGROUND Statins are widely prescribed for managing hypercholesterolemia and reducing cardiovascular risk but can cause myotoxicity ranging from mild myalgia to severe rhabdomyolysis. While statin-induced rhabdomyolysis typically manifests early, delayed-onset presentation is rare and poses diagnostic challenges. We report a rare case of delayed-onset rhabdomyolysis associated with rosuvastatin in a 63-year-old woman. CASE REPORT A 63-year-old woman with coronary artery disease, hyperlipidemia, and hypertension, which had been well-controlled on rosuvastatin (40 mg/day) for 1 year without adverse effects, developed progressive bilateral lower-limb swelling, pain, and weakness. One week after a fall attributed to sudden leg weakness, she presented to the emergency department with bilateral lower-extremity edema and moderate-to-severe pain on palpation. Laboratory findings showed markedly elevated creatine kinase (CK, 26 000 U/L), mildly elevated creatinine (1.3 mg/dL), and abnormal liver function. Rosuvastatin was discontinued on admission, and intravenous hydration was initiated. Magnetic resonance imaging confirmed diffuse muscle edema. A muscle biopsy revealed myofiber degeneration consistent with rhabdomyolysis, excluding autoimmune myopathies. CK peaked at 31 080 U/L on day 3, then declined with treatment. By day 10, CK and creatinine had returned to normal levels, muscle strength had improved, and the patient's edema had resolved. She was discharged after 2 weeks without restarting statins. CONCLUSIONS This case highlights the rare occurrence of delayed-onset statin-induced rhabdomyolysis, emphasizing the need for vigilant monitoring, prompt recognition, and cessation of statins to prevent severe complications, including acute kidney injury. Clinicians must remain alert to the potential of statin-induced myopathy, even in previously unaffected patients.