Severe rhabdomyolysis and acute kidney injury after starting rosuvastatin during ticagrelor therapy

A case describes severe rhabdomyolysis and acute kidney injury in a 66-year-old woman with type 2 diabetes mellitus, hypertension, and hyperlipidemia. After admission for acute coronary syndrome and implantation of a drug-eluting stent, she was prescribed rosuvastatin 40 mg once daily and ticagrelor 90 mg twice daily alongside other medications.

One month later, she developed generalized weakness, fatigue, and severe myalgia; initial investigations showed elevated creatinine and aminotransferases. Two days later, anuria, severe muscle pain, and dark-red urine developed. At admission, creatine kinase and creatinine were markedly elevated. She denied other medication use, toxic exposure, or recent muscle trauma.

Rosuvastatin was immediately discontinued, and ticagrelor was replaced with clopidogrel. Despite intravenous hydration and supportive treatment, metabolic acidosis and renal dysfunction worsened: creatinine was 6.3 mg/dL, blood urea nitrogen was 82 mg/dL, and bicarbonate was 15 mmol/L. Hemodialysis was initiated. On the fourth day, severe dyspnea and hypoxemia associated with pulmonary congestion required additional consecutive hemodialysis sessions. Cardiac causes of pulmonary edema were excluded by electrocardiography and echocardiography.

Her condition subsequently stabilized, and creatine kinase and creatinine progressively decreased. She was discharged with continued renal monitoring; creatinine decreased to 1.3 mg/dL by the third week after discharge. The authors emphasize early symptom recognition, withdrawal of the suspected medication, aggressive supportive management, and timely renal replacement therapy.