Case 22-2019: A 65-Year-Old Woman with Myopathy

To the Editor: The case reported by Freeman et al. (July 18 issue) 1 contains conclusions that may perpetuate misconceptions. The patient had acute rhabdomyolysis and necrotizing autoimmune myositis, but the connection with statins is unlikely. In this patient, myopathy started 2 weeks after coryza and cough; this suggests a preceding viral infection, which is a more likely trigger of necrotizing autoimmune myositis 2 than atorvastatin, which had been initiated 6 months previously. Statins can rarely lead to acute myotoxicity, but the contention that they induce anti-HMGCR (3-hydroxy-3-methylglutaryl coenzyme A reductase)–mediated autoimmunity is unsubstantiated and disputed. 3 HMGCR is normally expressed in regenerating . . .