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Age and Ageing Advance Access originally published online on May 16, 2008
Age and Ageing 2008 37(4):383; doi:10.1093/ageing/afn104
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Clinical Reminders

A case of recurrent rapidly progressive lower limb weakness

Kamala Mahmoud*, Domnick D'costa and Sue Dorrian

New Cross Hospital, Care of the Elderly, Wolverhampton, West Midlands WV11 1RH, UK

* To whom correspondence should be addressed E-mail: bitbaladi{at}hotmail.com

A 73-year-old man was admitted with progressive lower limb weakness of over 2 days. Cola-like urine was noted (see Appendix 1 in the supplementary data on the journal's website http://www.ageing.oxfordjournals.org.) and his CK was 16,788 U/L. He had a similar presentation with weak legs and renal failure, requiring temporary dialysis a year earlier. On both occasions fucidin had been commenced for a discharging sternal sinus. Other medications were simvastatin, omeprazole and aspirin. His symptoms promptly resolved after stopping simvastatin and fucidin. A diagnosis of rhabdomyolysis with myoglobinuria induced by the combination of fucidin and simvastatin was made.

Risk factors for statin-induced myopathy are higher doses, frail elderly, renal impairment, diabetes or multiple medications [1]. There are only three reports of fucidin and statin precipitating rhabdomyolysis [2–4].

Clinicians should consider rhabdomyolysis in any patient with weakness or reduced mobility while on statin. Visual examination of the urine is crucial. Pain or muscle tenderness is not always present. Timely recognition and intervention should help prevent the potentially serious complication of acute renal failure.


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   Supplementary data
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 Conflict of interest
 Supplementary data
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Supplementary data for this article are available online at http://ageing.oxfordjournals.org.


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 References
 

  1. Pastenak RC, Smith SC, Balirey-Merz CN. ACC/AHA/NHLBI Clinical advisory on the use and safety of statins. J Am Coll Cardiol (2002) 40:567–72.[Free Full Text]
  2. Yuen SLS, McGaritey B. Rhabdomyolysis secondary to interaction of Fusidic Acid and Simvastatin. Med J Aust (2003) 179:172.[Web of Science][Medline]
  3. Wenisch C, Krause R, Fladerer P, et al. Acute rhabdomyolysis after Atorvastatin and Fusidic acid therapy. Am J Med (2000) 109:78.[Web of Science][Medline]
  4. Kotanko P, Kirisits W, Skrabal F. Rhabdomyolysis and acute renal graft impairment in a patient treated with Simvastatin, Tacrolimus and Fusidic Acid. Nephron (2002) 90:234–5.[CrossRef][Web of Science][Medline]

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This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow Supplementary Data
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37/4/383    most recent
afn104v1
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Right arrow Articles by Mahmoud, K.
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