Seronegative Immune-Mediated Necrotizing Myopathy: A Case Report

Patel, Sagar P.; Abu-Abaa, Mohammad; Mousavi, Feryal

doi:10.7759/cureus.27824

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…We consider this case to be different from other similar cases published of seronegative IMNM, due to the severity of clinical presentation. Our patient presented to the emergency department with severe motor impairment, a very marked elevation of serum levels of muscle enzymes, and severe acute kidney injury, in a subacute evolution (six weeks versus four to five months as in other case reports) [ 9 - 12 ]. The serum levels of muscle enzymes are significant (268 times the normal range for creatine kinase, 63 times for myoglobin, and 40 times for aldolase).…”

Section: Discussionmentioning

confidence: 56%

A Rare Case of Rhabdomyolysis

Pombo¹,

Raposo²,

Martins³

et al. 2022

Cureus

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Rhabdomyolysis is a pathological condition presenting with symptoms of localized or generalized myalgia and weakness, associated with an increase in serum creatine kinase level and, often leading to myoglobinuria and acute kidney injury. It has a wide range of etiologies. Immune-mediated necrotizing myopathy (IMNM) is a rare type of inflammatory myopathy, that leads to rhabdomyolysis, and it is divided into three different subtypes: anti-3-hydroxy-3-methylglutaryl-coA reductase (anti-HMGCR, anti-signal recognition particle (anti-SRP), and seronegative. There are slight differences in incidence, age of onset, clinical course, and prognosis between these subtypes.We describe the case of a 67-year-old female with myalgias and weakness of the thighs for six weeks. Laboratory findings showed marked rhabdomyolysis and severe acute kidney injury. The workup led to the diagnosis of seronegative immune-mediated necrotizing myopathy (IMNM) and treatment with corticosteroid and methotrexate was introduced, which led to marked clinical improvement.

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Section: Discussionmentioning

confidence: 56%

A Rare Case of Rhabdomyolysis

Pombo¹,

Raposo²,

Martins³

et al. 2022

Cureus

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“…Immune-mediated necrotizing myopathy (IMNM) is a form of myositis distinguished by severe muscle weakness, significantly elevated creatine kinase (CK) levels, and muscle necrosis with minimal inflammation observed in muscle biopsy [ 1 ]. Myositis is a serious and uncommon complication of coxsackie B virus infection [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Steroid-Responsive Seronegative Immune-Mediated Necrotizing Myopathy Likely Triggered by Coxsackie B Virus: A Case Report

Kumar,

Ali,

Kumar

et al. 2024

Cureus

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Viral myositis can be mistaken for other types of myopathies, and the main causes of muscle damage are direct myotoxic effect and immune-mediated mechanisms. The biochemical parameters, electromyography (EMG), and muscle biopsy findings can be similar in viral myositis and idiopathic inflammatory myopathies. Viruses are rarely isolated from muscle biopsy specimens, so clinical evaluation and ancillary tests are necessary for a definitive diagnosis. Viral etiology is suspected when weakness occurs after a respiratory or gastrointestinal infection. Coxsackieviruses, particularly A9 and B5, can cause myositis and muscle necrosis. This is a case of a 47-year-old female with a history of alcoholic cirrhosis and a recent coxsackie B virus infection presented with weakness, numbness, and body pain. Creatine kinase levels were elevated but tests for extended myositis panel and antibodies were negative. A muscle biopsy revealed immune-mediated inflammatory myopathy. After a week without improvement, the patient received IV methylprednisolone followed by prednisone taper leading to improvement in symptoms. Prolonged myalgia has been observed in patients recovering from coxsackie A infections. The role of coxsackie B in causing myositis is still disputed and requires more reported data and guidelines. Clinicians should consider testing for coxsackie B as a potential cause of weakness. Awareness of potential complications like myositis can aid in effective patient management. More cases are needed to determine the significance of steroid use in managing coxsackie B-related muscle weakness.

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“…Immune-mediated necrotizing myopathy (IMNM) is an increasingly common and serious condition in which autoantibodies attack muscle fbers causing clinically signifcant muscle weakness, fatigue, and myalgia [1][2][3]. IMNM can be classifed into three subtypes: antisignal recognition particles, anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR), and seronegative [4]. Recognizing the clinical presentation of IMNM is difcult but necessary, as rapid intervention decreases morbidity of this disease [5].…”

Section: Introductionmentioning

confidence: 99%

Immune-Mediated Necrotizing Myopathy Manifesting after Five Years of Statin Therapy

DeRon

Fischer

Lopez

et al. 2023

Case Reports in Rheumatology

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Immune-mediated necrotizing myopathy (IMNM) is an increasingly common and serious condition in which autoantibodies attack muscle fibers causing clinically significant muscle weakness, fatigue, and myalgias. Recognizing the clinical presentation of IMNM is difficult but necessary, as rapid intervention decreases morbidity. We present a case of a 53-year-old female with IMNM induced by statin therapy with confirmed anti-3-hydroxy-3-methylglutaryl coenzyme A reductase antibodies present on serologic testing. The patient’s statin therapy was halted, and the patient was provided with one dose of methylprednisolone and ongoing therapy with mycophenolate. She showed subsequent slow improvements in her muscle weakness and myalgias. It is important for clinicians to be aware of the possible consequences of statin therapy, as these drugs are generally regarded as benign in the medical community. Clinicians should also be aware that statin-induced myopathy can occur at any time during statin therapy. The condition does not necessarily correlate with beginning a new statin medication, as demonstrated in this case in which the patient was on chronic statin therapy before developing symptoms. Continued clinician education and building the fund of medical knowledge regarding this disease are vital to enable clinicians to recognize this disease and act promptly to reduce patient morbidity and improve outcomes.

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Seronegative Immune-Mediated Necrotizing Myopathy: A Case Report

Cited by 3 publications

References 18 publications

A Rare Case of Rhabdomyolysis

A Rare Case of Rhabdomyolysis

Steroid-Responsive Seronegative Immune-Mediated Necrotizing Myopathy Likely Triggered by Coxsackie B Virus: A Case Report

Immune-Mediated Necrotizing Myopathy Manifesting after Five Years of Statin Therapy

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