Necrotizing myopathy with elevated anti‐HMGCR antibodies following exposure to the supplement Bacopa

Abstract

One of the main subtypes of immune-mediated necrotizing myopathies (IMNM) is defined by the presence of autoantibodies against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR). Statins lower cholesterol through inhibition of HMGCR. 1 Rarely, they can cause a severe immune-mediated anti-HMGCR positive myopathy that persists despite discontinuation of statins and requires immunosuppression. 1 In addition, patients with anti-HMGCR-related myositis do not always have history of statin exposure.