A middle-aged man presented with joint pain and muscle weakness that had begun 2 months before presentation. Three months before presentation, he had begun to take the herbal preparation Chinese red rice. Laboratory testing revealed a moderately elevated creatine phosphokinase level. Symptoms and laboratory abnormalities resolved with discontinuation of the Chinese red rice. Eight months later, he resumed the product and his creatine phosphokinase level rose again. Lovastatin is a naturally occurring component of Chinese red rice and was the probable cause of his myopathy.
Herbal product use is increasing in popularity in the United States. 1 Herbal remedies are used to prevent and to alleviate symptoms of disease. 2 In 1999, the Centers for Disease Control and Prevention reported that 10% of adults used herbal preparations and 29% used some form of complementary or alternative medicine. 3 Herbal preparations are easily obtainable by the general public at most health food stores. Information regarding their use is widespread on the Internet. Herbal preparations are not required to meet the standards of other proprietary drugs, because they are marketed as dietary supplements. 3 It is a challenge for most medical professionals to maintain a working knowledge of contents and adverse effects of the various herbal preparations on the market today. However, some herbal preparations can have clinically significant adverse effects. For example, the Chinese herb Aristolochia fangchi has been reported to increase urothelial carcinoma among patients with end-stage Chinese herb nephropathy. 4 One case report described proximal muscle weakness associated with the ingestion of an herb purchased in Mexico that contained triamcinolone. 5 We report a case of symptomatic myopathy associated with the use of Chinese red rice.