Abstract
We report a fatal case of toxic myopathy in a patient with a transplanted heart for severe ischemic coronary artery disease. He was on long-term cyclosporine, prednisone, and mycofenolate. Four months before the development of proximal muscle weakness, his simvastatin dose was doubled, and he was also started on colchicine for acute exacerbation of gout. He developed progressive muscle weakness leading to shortness of breath and hospitalization for respiratory failure. Colchicine and simvastatin were stopped on admission. He received high-dose methylprednisolone for continued muscle weakness while he was sedated with propofol. These changes led to a marked elevation of creatine kinase, peaking at 33,580 U/ml. The muscle biopsy revealed toxic vacuolization, mitochondrial damage, and no evidence of inflammation. Based on the timing of events, the combination of propofol, high-dose methylprednisolone, and cyclosporine have triggered rhabdomyolysis, which may have been facilitated by prior administration of colchicine and simvastatin.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Harris ED Jr, Budd RC, Firestein GS (2004) Kelley’s textbook of rheumatology (7th edn.). Saunders, Pennsylvania
Wahie S, Meggitt SJ (2005) Myotoxicity occurring with cyclosporine in a patient with atopic dermatitis. Br J Dermatol 153:1238
Rosenson R (2004) Current overview of statin induced myopathy. Am J Med 116:408–416
Jamal S, Eisenberg M, Christopoulos S (2004) Rhabdomyolysis associated with Hydroxy methylglutaryl–coenzyme A inhibitors. Am Heart J 147:956–965
Baker S, Goodwin S, Sur M et al (2004) Cytoskeletal myotoxicity from simvastatin and colchicine. Muscle Nerve 30:799–802
Sieb J, Gillesen T (2003) Iatrogenic and toxic myopathies. Muscle Nerve 27:142–156
Thompson P, Clarkson P, Karas R (2003) Statin associated myopathy. JAMA 289:1681–1690
Ballantyne C, Corsini A, Davidson M et al (2003) Risk for myopathy with statin therapy in high risk patients. Arch Intern Med 163:553–564
Fernandez C, Figarella- Branger D, Alla P et al (2002) Colchicine myopathy: a vacuolar myopathy with selective Type 1 muscle fiber involvement. Acta Neuropathol 103:100–106
Gruberg L, Zahav Y, Freimark A (1999) Acute myopathy induced by colchicines in a cyclosporine treated heart transplant recipient—possible role of multidrug resistance transporter. Transplant Proc 31:2157–2158
Nava S, Fracchia C, Callegari G et al (2002) Weakness of respiratory and skeletal muscles after a short course of steroids in patients with acute lung rejection. Eur Respir J 20:497–499
Ducloux D, Schuller V, Bresson-Vautrin C et al (1997) Colchicine myopathy in renal transplant recipients on cyclosporine. Nephrol Dial Transplant 12:2389–2392
Stelow EB, Johari VP, Smith SA et al (2000) Propofol associated rhabdomyolysis with cardiac involvement in adults: chemical and anatomic findings. Clin Chem 46:4577–4581
Eriksen J, Povey HMR (2006) A case of suspected and non- neurosurgical adult fatal propofol infusion syndrome. Acta Anaesthesiol Scand 50:117–119
Cremer OL, Moons KGM, Bouman EAC (2001) Longterm propofol infusion and cardiac failure in adult head injured. Lancet 357:606–607
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Francis, L., Bonilla, E., Soforo, E. et al. Fatal toxic myopathy attributed to propofol, methylprednisolone, and cyclosporine after prior exposure to colchicine and simvastatin. Clin Rheumatol 27, 129–131 (2008). https://doi.org/10.1007/s10067-007-0696-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-007-0696-9