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Background and objective: Statins are increasingly recommended in patients with liver cirrhosis due to their cardiovascular benefits and potential positive effects on portal hypertension and overall survival. However, patients with advanced cirrhosis are at increased risk for statin-associated muscle toxicity, particularly in the presence of additional risk factors.

Method: We report the case of a 61-year-old male patient with primary sclerosing cholangitis and decompensated liver cirrhosis (Child–Pugh B) listed for liver transplantation. The patient presented to the transplant outpatient clinic with a sudden and marked elevation of serum transaminases despite previously stable liver function. Clinically, he complained of myalgia and muscle weakness. Laboratory investigations revealed a massive increase in creatine kinase levels accompanied by early deterioration of renal function. Further diagnostic work-up confirmed the diagnosis of severe rhabdomyolysis. A medication error in the context of ongoing statin therapy with atorvastatin was identified as the most likely trigger, facilitated by underlying liver cirrhosis and comorbid conditions.

Result: Statin therapy was discontinued immediately. The patient was treated with intensive intravenous fluid substitution, close monitoring of renal function, electrolytes, body weight, and urine output, while diuretic therapy was continued. Under these measures, laboratory parameters and clinical symptoms improved rapidly, and renal replacement therapy was not required.

Summary: This case highlights the importance of careful patient selection, dose adjustment, and close monitoring when prescribing statins in patients with advanced liver cirrhosis. Early recognition of myopathy symptoms and prompt intervention are crucial to prevent severe complications such as rhabdomyolysis.