An autoimmune reaction to a common cholesterol drug
When 77-year-old Ami Dvorat suddenly experienced unexplainable symptoms, he never imagined the cause—an autoimmune reaction to a common cholesterol drug. It was a race against time, but luckily, a leading expert at Rambam Health Care Campus (Rambam) recognized the cause and saved his life.
Ami Dovrat is an active person with a passion for travel and the outdoors, but three months ago, his life took a sudden and alarming turn. He had difficulty walking and swallowing, felt weak, and had muscle pain. “I’m used to the outdoors and jumping across and climbing rocks,” he explains. “Suddenly, I started waddling like a duck, and my left leg kept collapsing.” As time went by, his condition worsened; he could not lift his knee while dressing and was often forced to sit down. “When we went on field trips, I stayed in the car. My friends were concerned, and I was depressed and scared,” he recalls.
Dvorat’s family doctor referred him to the Green-Wagner Department of Emergency Medicine at Rambam, and from there, he was transferred to the Department of Neurology, where he underwent a battery of blood and advanced imaging tests. The tests ruled out a wide range of possibilities, which led the medical team to suspect he was suffering from a rare reaction to a cholesterol-lowering drug (a statin) he had been taking for nearly a decade.
Immune-mediated necrotising myopathy
While hospitalised, he was treated by Dr. Shahar Shelly, director of the Department of Neurology. Shelly is one of only a handful of physicians globally who have experience in this rare condition: immune-mediated necrotising myopathy. The condition causes the body to attack its own muscle tissue, leading to necrosis, including the muscles responsible for breathing and heart function. It can be life-threatening. “Elevated cholesterol is common and statins are effective, considered safe and widely used to lower the levels,” says Shelly. In rare cases—about 11 in 100,000—statins can trigger a severe autoimmune response. “Symptoms often mimic other diseases, making diagnosis difficult, but in lab tests, we can identify immune-mediated necrotising myopathy’s unique signature, and we were able to do so.” Treatment protocols which are similar to immunotherapy protocols, and they saved Dvorat’s life.
Published three years ago, Shelly first described the disease in a study he led at the Mayo Clinic in Rochester, Minnesota. “The disease is rare, but its prevalence increases significantly among patients taking statins,” he adds. “This disease has no rules. It can appear after two weeks or twenty years of statin use. What matters is recognising it and acting fast.”
“Fortunately, Ami was referred to the Department of Neurology, and alongside senior physicians and the EMG (electromyography) team at Rambam, we were able to diagnose and treat the disease,” reports Shelly.
When Dvorat’s health improved, he was discharged and continues to recover at home. “Now, I walk several times a week,” he says, “and have returned to making field trips. I feel like myself again.”
Based on an article that first appeared on the Mako website
