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Statin-associated myotoxicity in an incarcerated Indigenous youth — the perfect storm

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Clinical record

A previously healthy 18-year-old dark-skinned Indigenous man was incarcerated in a juvenile detention centre in New South Wales for 3.5 years from 2010 to 2013. Juvenile detention limits outdoor activity and, consequently, exposure to sunlight. Young people are confined indoors for schooling and other programs, with additional periods of cell lockdowns to accommodate detainee movements and staff handovers. Periods outdoors involve bursts of strenuous physical activity, mostly team sports or swimming. Further, detention centre policy requires young people to wear T-shirts and hats, and to use sun protection factor 30+ sunscreen when outdoors.

On entering custody, the patient’s weight was 65 kg, with a healthy body mass index (BMI) of 21 kg/m2 (reference interval [RI], 18.5–24.9 kg/m2). Full blood count, urea, electrolyte and creatinine levels and liver function test results were normal, and a blood-borne virus screen returned a negative result. He had a strong family history of type 2 diabetes in his mother and maternal grandmother, and, reportedly, of hypercholesterolaemia and early cardiovascular death in his father and paternal grandfather.

Seven months after incarceration, the man developed auditory and visual hallucinations and was noted to be withdrawn and depressed, with long periods spent resting in his cell owing….