WHEN A PATIENT PRESENTS WITH WEAKNESS: IT MAYBE HELPFUL TO REVIEW YOUR PRESCRIPTION. A. Arshad 1 , R. Keating 1 ; 1 Fairview Hospital, Cleveland, OH LEARNING OBJECTIVES: 1) Diagnose drug-induced myositis from its presentation. 2) Recognize how adding multi drug antihyperlipidemic therapy increases the incidence of myositis. CASE INFORMATION: A 72 year old white female with past medical history of diabetes mellitus, hypertension and hyperlipidemia who was in relatively good health presents with progressive weakness for the last one week. A week ago she had a yeast infection and took two tablets of diflucan. Shortly after she started feeling weak and the weakness progressed gradually. She is now unable to stand or walk has trouble feeding due to weakness in her arms and also occasionally gets short of breath. She denies any headache, double vision, blurred vision, fevers, chills, pain in her muscles or joints or any recent falls. She is currently on cerivastatin, insulin, lansoprazole, gemfibrozil, atenolol, aspirin, nortriptyline, sertraline, and lisinopril. On physical examination she is afebrile with stable vital signs. The muscle strength was severely decreased in all extremities, upper greater than lower and especially in the shoulder and pelvic girdles. No skin rash or mouth ulcers were seen. Laboratory work shows a creatine kinase of 4132 U/L, myoglobin titer of 3634. Liver enzymes were mildly elevated. Patient was started on steroids and she adequately recovered. DISCUSSION: The onset of generalized progressive myopathy in a patient taking cholesterol lowering drugs should alert us to the diagnosis of drug induced myopathy. Several antihyperlipidemic drugs have caused myopathy including the statins, gemfibrozil, nicotinic acid and clofibrate. Lovastatin has been reported several times in literature to induce myositis. The concomitant use of gemfibrozil in patients taking statins increases the incidence of myositis to five percent. The creatine kinase and sedimentation rate is markedly elevated in these patients. Creatine kinase elevations are very specific and consist of only the MM fraction. Discontinuation of statin therapy in these patients is advisable because of the potential development of rhabdomyolysis and acute renal failure. Cautious use of statins is recommended in patients with prior history of liver disease, those with active liver disease and in heavy alcohol users. Hepatic and muscle enzyme levels should be tested periodically during statin treatment. Other medications known to increase the incidence of myopathy in patients taking statins are cyclosporine, nicotinic acid, prednisone and azathioprine. Treatment includes discontinuation of the medication and use of steroids. The use of diflucan was most likely incidental as there have not been cases of myopathy attributed to diflucan. 2) Recognize Propionibacterium acnes as a cause of intra-cranial abscess.