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Oropharyngeal Dysphagia: Rare Presenting Symptom of Statin-induced HMG CoA Reductase Necrotizing Autoimmune Myopathy

Vatsal Bhatt, Clifford Stermer, Vivien Hsu and Ranita Sharma

Necrotizing Autoimmune Myopathy (NAM) associated with 3-hydroxy-3-methylglutarylcoenzyme A Reductase (HMGCR) antibodies has been described in statin-induced and statin-naive patients. Proximal muscle weakness is the presenting symptom in HMGCR NAM. Creatine Kinase (CK) levels can exceed 10x normal values. Statininduced cases involve two thirds of HMGCR NAM patients and are more likely to respond to immunosuppressive therapy. Muscle biopsy confirms the diagnosis. We report a case with progressive oropharyngeal dysphagia as the presenting complaint with delayed response to treatment. To our knowledge, there has been only one previously reported case of statin-exposed HMGCR NAM with a similar presentation.