Jornal de Prática Geral

Simvastatin-Induced Pleuro-Pericardial Effusion and Megaloblastic Anemia

Abstract

Ali A. Alzu'bi

Statins competitively inhibit 3-hyroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, an enzyme involved in cholesterol synthesis, especially in the liver. Statins are considered for all patients with cardiovascular diseases such as coronary heart disease, peripheral vascular disease, non-haemorrhagic stroke, and transient ischemic attacks. Pleural and pericardial effusions may be caused by infectious diseases, malignancies and autoimmune disorders. However, unexplained effusions should raise the possibility of drugs as being the cause. Drug-induced anemia may be in the form of auto-immune or oxidative hemolysis, aplastic anemia, sideroblastic anemia or megaloblastic anemia. I report a case of lymphocytic pleural effusion, pericardial effusion and megaloblastic anemia in a patient known to have ischemic stroke, diabetes mellitus and hypertension. In the view of un-yielding clinical and laboratory evaluation, a drug-induced reaction was suspected. Because of the recent addition of simvastatin to the patient's regimen, the improvement of the patient's condition after discontinuation of simvastatin and recurrence of symptoms following it's re-administration, a conclusion was made that simvastatin may be the cause of the patient's clinical picture and should be further considered as a cause of unexplained pleural and pericardial effusions, and megaloblastic anemia.