A rare case of anti-HMGCR and anti-SRP-positive immune-mediated necrotizing myopathy

Abstract EN

Immune-mediated necrotizing myopathy (IMNM) or necrotizing autoimmune myopathy includes a set of distinct disorders associated with marked myasthenia, myofiber necrosis, and high creatine kinase levels.

Anti-3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR) and anti-signal recognition particle (anti-SRP) are the two main autoantibodies associated with IMNM.

Anti-HMGCR is usually associated with statin use.

However, it may also be discovered in children without previous statin exposure, suggesting the existence of a complex genetic–environmental relationship in disease pathogenesis.

Anti-SRP IMNM tends to present with more severe disease distinguished by pronounced myasthenia, worse neurologic outcomes, and treatment refractoriness.

Its pathogenesis is also unknown; however, preliminary data suggest an antibody–complement-mediated mechanism of muscle cell lysis.

Herein, we present the case of a 63-year-old man diagnosed with anti-HMGCR- and anti-SRP-positive IMNM that was treated with multiple immunosuppressants resulting in clinical improvement.