Rhabdomyolysis Following Addition of Ezetimibe to Chronic Rosuvastatin Therapy in an Elderly Female with Chronic Kidney Disease: A Case Report

Background: Statins are often the most used lipid-lowering therapy for the prevention of atherosclerotic cardiovascular disease. Usually statins are well tolerated, but occasionally, statin associated muscle toxicity can rarely progress to severe rhabdomyolysis with acute kidney injury and multiorgan dysfunction. Advanced age, female sex, diabetes mellitus, and chronic kidney disease are recognized risk factors for statin-associated muscle injury. Case Presentation: An 89-year-old Asian female with a history of type 2 DM, chronic kidney disease stage 3A, coronary artery disease, hyperlipidemia, osteoporosis, and glaucoma presented with progressive bilateral lower extremity weakness and inability to ambulate approximately one month after ezetimibe was added to the chronic rosuvastatin therapy. Laboratory evaluation revealed severe rhabdomyolysis with a creatine kinase (CK) level of 12,851 U/L, acute kidney injury with serum creatinine of 2.3 mg/dL, and marked transaminitis with AST 454 U/L and ALT 403 U/L. Both medications were discontinued and IV hydration was started on the patient. The patient demonstrated progressive clinical improvement with declining CK levels and recovery of renal and hepatic function. Follow up laboratory studies demonstrated a return to baseline of liver enzymes and renal function. Lipid management was subsequently transitioned to a PCSK9 inhibitor without recurrence of symptoms. Conclusion: This case highlights the potential for severe statin-associated rhabdomyolysis in elderly patients with chronic kidney disease receiving combination lipid-lowering therapy. Prompt recognition, medication discontinuation, and aggressive fluid resuscitation remain critical to preventing permanent organ injury.