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Nonspecific Interstitial Pneumonia: A Rare Adverse Reaction of Atorvastatin
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A6650 - Nonspecific Interstitial Pneumonia: A Rare Adverse Reaction of Atorvastatin
Author Block: J. Xu1, S. Verga1, J. Stoll1, W. Khan2; 1Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States, 2University Medical Center of Princeton, Plainsboro, NJ, United States.
Introduction Statins have been shown to effectively prevent both cardiovascular morbidity and mortality by inhibiting the hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase enzyme. Pulmonary complications are very rare, and can include pneumonitis, pleural effusion, and nonspecific interstitial pneumonia (NSIP). There have been very few previously documented cases of statin-induced fibrotic NSIP.
Case Report We present a 73-year-old female with a history of hypertension, diabetes, and hyperlipidemia who presented with a several month history of shortness of breath. She was a lifelong non-smoker without history of occupational exposures. There was no history of connective tissue disease. Home medications included atorvastatin, lisinopril, metformin, fenofibrate, aspirin, and verapamil. Computed tomography scan of the chest revealed interstitial infiltrates with bilateral ground-glass opacities. She underwent a surgical lung biopsy which showed uniform fibrous alveolar septal thickening, scattered collections of alveolar macrophages and inflammation, along with areas of fibrosis. The findings were most suggestive of fibrotic NSIP. Atorvastatin was stopped and she was started on oral glucocorticoids with improvement of her symptoms.
Discussion Statins are increasingly prescribed to reduce cholesterol and improve cardiovascular health. They are among the most widely prescribed drugs in the world. Although rare, the clinician should be aware of possible pulmonary complications of statin therapy. The exact mechanism of injury is unclear, however immunological or toxicological mechanisms are implicated. Statins may have a toxic effect leading to activation of an inflammatory immune response, possibly mediated by the inhibition of phospholipadases and thus leading to cellular accumulation of intralysosomial phospholipids. One case series of statin induced interstitial lung disease showed some improvement of dyspnea with systemic glucocorticoids and termination of statin therapy. Statins, specifically pravastatin, lovastatin, and simvastatin have been associated with drug induced pneumonitis and interstitial lung disease.
Author Block: J. Xu1, S. Verga1, J. Stoll1, W. Khan2; 1Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States, 2University Medical Center of Princeton, Plainsboro, NJ, United States.
Introduction Statins have been shown to effectively prevent both cardiovascular morbidity and mortality by inhibiting the hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase enzyme. Pulmonary complications are very rare, and can include pneumonitis, pleural effusion, and nonspecific interstitial pneumonia (NSIP). There have been very few previously documented cases of statin-induced fibrotic NSIP.
Case Report We present a 73-year-old female with a history of hypertension, diabetes, and hyperlipidemia who presented with a several month history of shortness of breath. She was a lifelong non-smoker without history of occupational exposures. There was no history of connective tissue disease. Home medications included atorvastatin, lisinopril, metformin, fenofibrate, aspirin, and verapamil. Computed tomography scan of the chest revealed interstitial infiltrates with bilateral ground-glass opacities. She underwent a surgical lung biopsy which showed uniform fibrous alveolar septal thickening, scattered collections of alveolar macrophages and inflammation, along with areas of fibrosis. The findings were most suggestive of fibrotic NSIP. Atorvastatin was stopped and she was started on oral glucocorticoids with improvement of her symptoms.
Discussion Statins are increasingly prescribed to reduce cholesterol and improve cardiovascular health. They are among the most widely prescribed drugs in the world. Although rare, the clinician should be aware of possible pulmonary complications of statin therapy. The exact mechanism of injury is unclear, however immunological or toxicological mechanisms are implicated. Statins may have a toxic effect leading to activation of an inflammatory immune response, possibly mediated by the inhibition of phospholipadases and thus leading to cellular accumulation of intralysosomial phospholipids. One case series of statin induced interstitial lung disease showed some improvement of dyspnea with systemic glucocorticoids and termination of statin therapy. Statins, specifically pravastatin, lovastatin, and simvastatin have been associated with drug induced pneumonitis and interstitial lung disease.
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