A Case Report of Anti–3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Immune-Mediated Necrotizing Myopathy

We present a 75-year-old woman with 3 months of progressive proximal muscle weakness, myalgias, and dysphagia. Her admission was complicated by acute hypoxic respiratory failure requiring admission to the intensive care unit. Her clinical presentation and laboratory investigations were consistent wi...

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Bibliographic Details
Main Authors: Monique Crawford, Xiaoshan Gong, Johnny M. Trinh, Sachin Chaudhary
Format: Article
Language:English
Published: American College of Physicians 2025-06-01
Series:Annals of Internal Medicine: Clinical Cases
Online Access:https://www.acpjournals.org/doi/10.7326/aimcc.2024.1120
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Summary:We present a 75-year-old woman with 3 months of progressive proximal muscle weakness, myalgias, and dysphagia. Her admission was complicated by acute hypoxic respiratory failure requiring admission to the intensive care unit. Her clinical presentation and laboratory investigations were consistent with typical and atypical signs and symptoms of anti–3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) immune-mediated necrotizing myopathy (IMNM). Treatment with intravenous immunoglobulin, intravenous methylprednisolone, and oral methotrexate provided immediate relief of symptoms, further supporting the diagnosis of anti-HMGCR IMNM. We discuss the atypical presentations of anti-HMGCR IMNM and the complication of bulbar involvement leading to respiratory failure.
ISSN:2767-7664