Toxische Myopathie

Zusammenfassung

Viele Medikamente können Myopathien auslösen. Statine sind dabei die häufigste Ursache, aber auch Amiodaron, Chlorochin, antiretrovirale Medikamente, Kortikosteroide und Checkpoint-Inhibitoren sind potentiell myotoxisch. Häufigster nicht-medikamentöser Auslöser ist Alkoholismus. Pathogenetisch spielen unterschiedliche, meist nicht völlig verstandene Mechanismen eine Rolle. Symptome reichen von milden Myalgien und Krampi bis hin zu hochgradigen Paresen, Myoglobinurien und lebensbedrohlicher Rhabdomyolyse. Diagnostisch sind die Anamnese einer Exposition gegenüber Noxen sowie von Risikofaktoren, die klinische Untersuchung, die CK-Wert-Bestimmung und Elektromyographie wegweisend. Eine Muskelbiopsie ist oft für die Diagnosesicherung nötig. Das frühzeitige Erkennen von toxischen Myopathien ist relevant, da eine Beendigung des Auslösers meist zur prompten Symptombesserung führt. Selten wird eine immunvermittelte Muskelschädigung angestoßen, die eine spezifische Immuntherapie erfordert.

Abstract

For many drugs myopathy can occur as sideaffect, with statins being the most frequent cause. However, other substances, e. g. amiodarone, chloriquin, antiretrovirals, corticosteroids, and checkpoint-inhibitors are also potentially myotoxic. Alcoholism is the most common trigger in toxic myopathy of other origin. Pathogenetic mechanisms are diverse and often poorly understood. Symptoms vary from mild myalgia and cramps to severe muscular weakness, myoglobinuria and life threatening rhabdomyolysis. Diagnosis is based on the exposure to noxious agents and individual risk factors, clinical examination, determination of CK value and eletromyography. A muscle biopsy is often required to confirm the diagnosis. Early detection of toxic myopathies ist relevant, since termination of the trigger leads to prompt improvement of symptoms in most cases. Immune-mediated muscle damage is a rare complication that requires a specific immunotherapy.

Schlüsselwörter

erworbene Myopathie - Statinmyopathie - alcohol myopathy - toxic myopathy - muskuläre Medikamentennebenwirkung

Key words

aquired myopathy - statin myopathy - Alkoholmyopathie - toxische Myopathie - muscular side effect of drugs

Publication History

Article published online:
02 March 2022

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