Rhabdomyolysis from Simvastatin Triggered by Infection and Muscle Exertion

Josef MD, Finsterer, PhD; Georg Zuntner, MD


South Med J. 2005;98(8):827-829. 

In This Article

Case Report

The patient is a 42-year-old, HIV-negative woman (height, 164 cm; weight, 60 kg) who had been receiving simvastatin (20 mg/d) for approximately 6 months because of an elevated serum cholesterol of 300 mg/dL. In August 2004, 1 hour after swimming in a cold mountain lake for 1 hour, she had fever up to 37.8ºC, tiredness, and myalgia. She self-medicated with diclofenac, and her symptoms gradually resolved within 2 weeks. Routine blood work later that month revealed elevated muscle function parameters ( Table 2 ). Clinical neurologic examination revealed bilateral ptosis and weakness of elbow extension on the right side. Nerve conduction studies of the right median and left peroneal nerve were normal. Needle electromyography of the right anterior tibial muscle showed some unstable, distorted motor-unit action potentials with normal mean duration, increased percent polyphasia, and increased percent satellite potentials. Needle electromyography of the right brachial biceps muscle was normal. The serum aldolase level was 55.9 U/L (normal, 0 to 7 U/L). Other blood test results are shown in Table 2 . After discontinuation of simvastatin, the patient's fatigue disappeared and serum muscle enzyme levels decreased to normal values within 14 days ( Table 2 ). The patient made an uneventful, complete recovery.


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