Simvastatin-Induced Myoglobinuric Acute Kidney Injury Following Ciclosporin Treatment for Alopecia Universalis

A 45-year-old woman treated with ciclosporin (CsA) for alopecia universalis developed severe myoglobinuric acute kidney injury after concomitant use of simvastatin, presenting with oligo-anuria and a serum creatinine level of 13.8 mg/dl. CsA and simvastatin were discontinued, and she underwent eight daily haemodialysis sessions. Her serum creatinine levels improved to 3.5 mg/dl after 1 month and 1.4 mg/dl after 2 months, with a creatinine clearance of 43.2 ml/min. The case highlighted the risks of combining CsA and statins, emphasizing the need for monitoring serum creatinine, muscle enzyme levels, blood CsA levels, and liver function tests, and advising patients to report muscle symptoms.