Statin-induced, immune-mediated injury with simultaneous targeting of skeletal muscle, skin and liver

Approximately 10% of patients treated with statins develop statin-associated muscle symptoms (SAMS) that, classically, remit with drug withdrawal. Statin administration has also been associated with autoimmune diseases such immune-mediated necrotizing myopathy (IMNM), which requires a differential diagnosis with SAMS, and autoimmune hepatitis (AIH). IMNM is less frequent (2–3 cases per 100,000 patients treated) than SAMS and does not resolve with interruption of statin administration. While immune-mediated tissue damage is a relatively common event, simultaneous appearance of multiple autoimmune-mediated clinical pictures is rare. Here, we report on the occurrence of statin-induced immune-mediated injury, with concomitant involvement of three targets: muscle, skin and liver.