Pravastatin-induced rhabdomyolysis in an elderly patient

A 78-year-old male patient with atherosclerotic heart disease intermittently took pravastatin 20 mg once every night and aspirin 100 mg once daily for 4 years.Three months ago,the patient presented to hospital with paroxysmal precordial discomfort,palpitations,and shortness of breath,and he was diagnosed with coronary heart disease.The patient then began to regularly take the above-mentioned 2 drugs at the same dosage as before.Eleven weeks later,the patient developed generalized muscle pain,limb weakness,dark urine,and oliguria with no other apparent precipatating causes.One day before admission,when the patient defecated,he developed tight chest,palpitations,and shortness of breath,and these symptoms did not completely resolve despite rest.Biochemical blood tests revealed the following levels and values: aspartate aminotransferase(AST)294 U/L,alanine aminotransferase(ALT) 180 U/L,lactate dehydrogenase(LDH) 677 U/L,hydroxybutyrate dehydrogenase(α-HBDH) 720 U/L,creatine kinase(CK) 12 210 U/L,and creatine kinase isoenzyme(CK-MB) 770 U/L.Pravastatin was stopped and symptomatic treatments were given.The patient' s muscle pain relieved 3 days later,and disappeared 1 week later.Two weeks later,the biochemical blood tests showed the following results: AST 16 U/L,ALT 24U/L,LDH 192 U/L,α-HBDH 225 U/L,CK 72 U/L,and CK-MB 1.3 U/L.The patient's symptoms did not recur,and his myocardial enzymes and liver enzymes were within normal ranges at a three-month follow-up.