Diagnostic and Therapeutic Challenges in Statin-Induced Necrotizing Autoimmune Myopathy in an Elderly Patient: A Rare Case Report.

We present the case of a 78-year-old woman with metabolic syndrome and a history of multiple ischemic strokes who developed progressive symmetrical proximal muscle weakness, predominantly affecting the lower extremities, while on atorvastatin. Laboratory evaluation revealed markedly elevated creatine kinase (CK) and positive anti-HMG-CoA reductase (anti-HMGCR) antibodies, with MRI confirming myositis consistent with statin-induced necrotizing autoimmune myopathy (SINAM). Despite statin discontinuation and immunosuppressive treatment, her muscle weakness persisted, and she remained bedbound at long-term follow-up. This case underscores the diagnostic and therapeutic challenges of SINAM in elderly patients with significant comorbidities and highlights the importance of early recognition and tailored management.