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Mushroom supplements triggering a flare of HMGCR immune mediated necrotising myopathy
  1. Brittany Adler,
  2. Lisa Christopher-Stine and
  3. Eleni Tiniakou
  1. Rheumatology, Johns Hopkins University, Baltimore, MD, USA
  1. Correspondence to Dr Brittany Adler; brit.adler{at}


Hydroxyl-methyl-glutaryl-Co-A reductase (HMGCR) immune mediated necrotising myopathy (IMNM) is a rare autoimmune myositis that is thought to be triggered by statins and responds to immunomodulation. We report a case of a woman in her 30s with HMGCR IMNM without a history of statin exposure who had a clear flare of her myositis after beginning mushroom supplements. Mushrooms are natural HMGCR inhibitors, and this is the first case to demonstrate a flare triggered by mushrooms in a patient with known HMGCR IMNM. This case highlights the importance of reviewing diet and supplements in patients with IMNM. It also emphasises the importance of strict statin avoidance for patients with IMNM even when the myositis is under good control.

  • Muscle disease
  • Drugs: musculoskeletal and joint diseases

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  • Contributors BA, ET and LC all conceived of the idea for the case report. BA wrote the manuscript, ET and LC critically reviewed the manuscript.

  • Funding This study was funded by Jerome Greene Scholar; Scleroderma Research Foundation (No award/grant number).

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.