BACKGROUND: Statins are fundamental to dyslipidemia management, but high-potency rosuvastatin can cause myotoxicity in vulnerable older patients. We present a probable case of rosuvastatin-associated rhabdomyolysis causing stage 3 acute kidney injury requiring hemodialysis in an 87-year-old woman with polypharmacy, highlighting clinical management and outcomes.

CASE REPORT: An octogenarian presented with progressive muscle weakness and inability to ambulate 20 days after starting rosuvastatin (20 mg/day), ezetimibe (10 mg/day), and evogliptin (5 mg/day). Laboratory tests revealed creatine kinase above 4267 U/L, serum creatinine 6.13 mg/dL, blood urea 220 mg/dL, severe hyponatremia (122 mEq/L), bicarbonate 15 mEq/L, and elevated transaminases (AST 419 U/L; ALT 342 U/L). Direct bilirubin (0.2 mg/dL) and gamma-glutamyl transferase (28 U/L) levels were normal, excluding primary hepatocellular or cholestatic liver injury. Urinalysis findings supported myoglobinuria. Refractory oliguria despite aggressive intravenous fluid resuscitation required emergency hemodialysis with sodium correction to prevent osmotic demyelination; rhabdomyolysis prompted rosuvastatin cessation. Concomitant nephrotoxic and renally cleared medications were temporarily withheld. During a 30-day hospital stay with 8 hemodialysis sessions, dialytic support was discontinued on Day 23 (serum creatinine 1.61 mg/dL). After physical rehabilitation, the patient was discharged on Day 30 with full motor strength (MRC grade 5/5). At 3 months, serum creatinine had stabilized (1.40 mg/dL; eGFR 38 mL/min/1.73 m²; creatine kinase 62 U/L) and independent ambulation continued.

CONCLUSIONS: Statin-associated rhabdomyolysis in older adults can be followed by renal recovery with dialysis independence and functional recovery through early drug cessation, fluid resuscitation, and timely dialytic support. Formal Naranjo assessment (score 5) classified the reaction as “probable,” highlighting the multifactorial risks of geriatric polypharmacy.

Keywords: Drug Combinations, Kidney Tubular Necrosis, Acute, rhabdomyolysis, rosuvastatin calcium