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Immune-mediated necrotising myopathy: a rare cause of hyperCKaemia
  1. Emily Liang1,
  2. Mandana Rastegar2,3
  1. 1University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
  2. 2Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
  3. 3Division of Nephrology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
  1. Correspondence to Dr Mandana Rastegar, mandana.rastegar{at}


Immune-mediated necrotising myopathy (IMNM) is a type of inflammatory myopathy characterised by acute or subacute severe proximal muscle weakness, significantly elevated creatine kinase levels, and prominent myofibre necrosis and regeneration with little or no inflammation. A subtype of IMNM identified by anti-HMG-CoA reductase (HMGCR)antibodies has been shown to be associated with statin exposure. Treatment of IMNM consists of immunosuppression with steroids, steroid-sparing agents, intravenous immune globulin and/or biologics. We present here a case of anti-HMCGR-associated IMNM and review the pathophysiology, diagnosis and treatment to increase physician awareness of this rare and debilitating condition.

  • musculoskeletal syndromes
  • disability
  • muscle disease
  • musculoskeletal and joint disorders

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  • Contributors EL, first author, contributed to the full initial draft of the document, including the case presentation and discussion, creating the table and summary points. I, MR, as her attending critically revised, edited and contributed throughout the article, assisting in interpreting and summarising the information conveyed.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

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