• Federica Fogacci, Claudio Borghi, Antonio Di Micoli, and CiceroArrigo F GAFG0000-0002-4367-3884Hypertension and Cardiovascular Risk Factors Research Group, Medical and Surgical Sciences Department, University of Bologna, 40138 Bologna, Italy.IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, It.
• Hypertension and Cardiovascular Risk Factors Research Group, Medical and Surgical Sciences Department, University of Bologna, 40138 Bologna, Italy.
• Medicina (Kaunas). 2021 Aug 24; 57 (8).

AbstractA 78-year-old man came to our attention after undergoing coronary computed tomography angiography documenting multivessel coronary artery disease. He was started on treatment with the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab 140 mg subcutaneously every 2 weeks. Treatment-emergent changes in lipids and lipoproteins were long-lasting, and the medication was well tolerated by the patient in the long-term. Unexpectedly, after 2 years of continuous treatment with evolocumab, serum lipids increased, apparently without any reasonable explanation. During the follow-up visit, the patient was found to have habitually injected evolocumab into his right thumb instead of into the appropriate injection sites (i.e., abdomen, thighs or upper arms) after turning the injector upside down.

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