論文

査読有り 国際誌
2020年6月

Recovery from hypoxemia and Hypercapnia following noninvasive pressure support ventilation in a patient with statin-associated necrotizing myopathy: a case report

BMC PULMONARY MEDICINE
  • Yuriko Yamamura
  • ,
  • Yoshinori Matsumoto
  • ,
  • Koh Tadokoro
  • ,
  • Yasuyuki Ohta
  • ,
  • Kota Sato
  • ,
  • Toru Yamashita
  • ,
  • Masahiro Yamamura
  • ,
  • Ken-Ei Sada
  • ,
  • Koji Abe
  • ,
  • Jun Wada

20
1
開始ページ
156
終了ページ
156
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1186/s12890-020-01195-7
出版者・発行元
BMC

Background Statin-associated necrotizing myopathy (SANM) is a rare autoimmune disorder caused by administration of statins. SANM is characterized by weakness due to necrosis and regeneration of myofibers. Here we report the first case of SANM with acute respiratory failure treated with noninvasive pressure support ventilation in addition to immunosuppressants. Case presentation A 59-year-old woman who had been treated with 2.5 mg/day of rosuvastatin calcium for 5 years stopped taking the drug 4 months before admission to our hospital due to elevation of creatine kinase (CK). Withdrawal of rosuvastatin for 1 month did not decrease the level of CK, and she was admitted to our hospital due to the development of muscle weakness of her neck and bilateral upper extremities. Anti-3-hydroxy-3-methylglutaryl coenzyme A reductase antibodies were positive. Magnetic resonance imaging showed myositis, and muscle biopsy from the right biceps brachii muscle showed muscle fiber necrosis and regeneration without inflammatory cell infiltration, suggesting SANM. After the diagnosis, she received methylprednisolone pulse therapy (mPSL, 1 g/day x 3 days, twice) and subsequent oral prednisolone therapy (PSL, 30 mg/day for 1 month, 25 mg/day for 1 month and 22.5 mg/day for 1 month), leading to improvement of her muscle weakness. One month after the PSL tapering to 20 mg/day, her muscle weakness deteriorated with oxygen desaturation (SpO2: 93% at room air) due to hypoventilation caused by weakness of respiratory muscles. BIPAP was used for the management of acute respiratory failure in combination with IVIG (20 g/day x 5 days) followed by mPSL pulse therapy (1 g/day x 3 days), oral PSL (30 mg/day x 3 weeks, then tapered to 25 mg/day) and tacrolimus (3 mg/day). Twenty-seven days after the start of BIPAP, she was weaned from BIPAP with improvement of muscle weakness, hypoxemia and hypercapnia. After she achieved remission with improvement of muscle weakness and reduction of serum CK level to a normal level, the dose of oral prednisolone was gradually tapered to 12.5 mg/day without relapse for 3 months. Conclusions Our report provides new insights into the role of immunosuppressants and biphasic positive airway pressure for induction of remission in patients with SANM.

リンク情報
DOI
https://doi.org/10.1186/s12890-020-01195-7
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/32493279
PubMed Central
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268346
Web of Science
https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000540247100001&DestApp=WOS_CPL
ID情報
  • DOI : 10.1186/s12890-020-01195-7
  • ISSN : 1471-2466
  • PubMed ID : 32493279
  • PubMed Central 記事ID : PMC7268346
  • Web of Science ID : WOS:000540247100001

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