A team from Stanford (USA) has published the case of a 21 year old man with no notable history or long-term treatment:
- he presented with myalgias, progressive muscle weakness, weight loss, elevated CPK and intermittent dark coloured urine.
- the work-up leads to the diagnosis of autoimmune necrotizing myopathy, with anti-HMGCR autoantibodies.
- the etiological investigation revealed that the patient had been taking a multivitamin supplement containing Bacopa, a plant supposed to improve concentration and memory, for five years.
Although the causal link between this plant and the onset of myositis remains to be demonstrated, previous studies have highlighted Bacopa’s ability to inhibit hydroxyl-methyl-glutaryl-Co-A reductase, or HMGCR. Statins have this same HMGCR inhibitory effect, and can trigger autoimmune necrotizing myopathy.