A Rare Case of Anti-HMGCR and Anti-SRP-Positive Immune-Mediated Necrotizing Myopathy

Nariman Khan; Zehra Kazmi

doi:10.5339/qmj.2022.6

ISSN: 0253-8253
EISSN: 2227-0426

oa A Rare Case of Anti-HMGCR and Anti-SRP-Positive Immune-Mediated Necrotizing Myopathy
Authors: Nariman Khan¹, Zehra Kazmi²
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Affiliations: ¹ UT Health San Antonio, Joe R. and Terry Lozano Long School of Medicine, Department of Internal Medicine, Texas, USA E-mail: [email protected] ² UT Health San Antonio, Joe R. and Terry Lozano Long School of Medicine, Department of Medicine, Division of Rheumatology, Texas, USA
Source: Qatar Medical Journal, Volume 2022, Issue 1, Jun 2022,
DOI: https://doi.org/10.5339/qmj.2022.6
- Received: 17 August 2021
- Accepted: 09 November 2021
- Published online: 22 February 2022

Abstract

Immune-mediated necrotizing myopathy (IMNM) or necrotizing autoimmune myopathy includes a set of distinct disorders associated with marked myasthenia, myofiber necrosis, and high creatine kinase levels. Anti-3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR) and anti-signal recognition particle (anti-SRP) are the two main autoantibodies associated with IMNM. Anti-HMGCR is usually associated with statin use. However, it may also be discovered in children without previous statin exposure, suggesting the existence of a complex genetic–environmental relationship in disease pathogenesis. Anti-SRP IMNM tends to present with more severe disease distinguished by pronounced myasthenia, worse neurologic outcomes, and treatment refractoriness. Its pathogenesis is also unknown; however, preliminary data suggest an antibody–complement-mediated mechanism of muscle cell lysis. Herein, we present the case of a 63-year-old man diagnosed with anti-HMGCR- and anti-SRP-positive IMNM that was treated with multiple immunosuppressants resulting in clinical improvement.

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References

Upreti S, Fayyaz B, Bongu RP: Anti-HMG-CoA reductase myopathy, an undesirable evolution of statin induced myopathy: a case report. J Community Hosp Intern Med Perspect. 2019, 9:33-35. 10.1080/20009666.2019.1571882.
[Google Scholar]
Greenberg, SA: Pathogenesis of inflammatory myopathies. UpToDate. Targoff IN, Shefner JM, Ramirez-Curtis M (ed): UpToDate, Waltham, MA; 2021.
[Google Scholar]
Ladislau L, Arouche-Delaperche L, Allenbach Y, Benveniste O: Potential pathogenic role of anti-signal recognition protein and anti-3-hydroxy-3-methylglutaryl-coa reductase antibodies in immune-mediated necrotizing myopathies. Curr Rheumatol Rep. 2018, 20:56. 10.1007/s11926-018-0763-z.
[Google Scholar]
Villa L, Lerario A, Calloni S, Peverelli L, Matinato C, DE LISO FE, et al.: Immune-mediated necrotizing myopathy due to statins exposure. Acta Myol. 2018, 37:257-262.
[Google Scholar]
Mohassel P, Mammen AL: Anti-HMGCR myopathy. J Neuromuscul Dis. 2018, 5:11-20. 10.3233/JND-170282.
[Google Scholar]
Khan MH, Patel A, Pendharkar S: Anti-signal recognition particle necrotizing autoimmune myopathy: an atypical presentation. Cureus. 2018, 10:e3766. 10.7759/cureus.3766.
[Google Scholar]
Watanabe Y, Uruha A, Suzuki S, Nakahara J, Hamanaka K, Takayam K, et al.: Clinical features and prognosis in anti-SRP and anti-HMGCR necrotising myopathy. J Neurol Neurosurg Psychiatry. 2016, 87:1038-1044. 10.1136/jnnp-2016-313166.
[Google Scholar]
Rojana-udomsart A, Mitrpant C, Bundell C, Price L, Luo YB, Fabian V, et al.: Complement-mediated muscle cell lysis: a possible mechanism of myonecrosis in anti-SRP associated necrotizing myopathy (ASANM). J Neuroimmunol. 2013, 264:65-70. 10.1016/j.jneuroim.2013.08.008.
[Google Scholar]
Benveniste O, Drouot L, Jouen F, Charuel JL, Bloch-Queyrat C, Behin A, et al.: Correlation of anti-signal recognition particle autoantibody levels with creatine kinase activity in patients with necrotizing myopathy. Arthritis Rheum. 2011, 63:1961-1971. 10.1002/art.30344.
[Google Scholar]
Kalinova D, Kopchev A, Kolarov Z, Rashkov R: Immune-mediated necrotizing myopathy with anti-SRP autoantibodies and typical clinical presentation. Clin Med Rev Case Rep. 2020, 7:314. 10.23937/2378-3656/1410314.
[Google Scholar]

http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2022.6

Article Type: Case Report

Keyword(s): Anti-HMGCR, anti-SRP, immune-mediated necrotizing myopathy, rheumatology and statin use

oa A Rare Case of Anti-HMGCR and Anti-SRP-Positive Immune-Mediated Necrotizing Myopathy

Abstract

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