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Chen BH, Zhu XM, Xie L, Hu HQ. Immune-mediated necrotizing myopathy: Report of two cases. World J Clin Cases 2023; 11:3552-3559. [PMID: 37383916 PMCID: PMC10294185 DOI: 10.12998/wjcc.v11.i15.3552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/25/2023] [Accepted: 04/24/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Immune-mediated necrotizing myopathy is a rare autoimmune myopathy characterized by muscle weakness and elevated serum creatine kinase, with unique skeletal muscle pathology and magnetic resonance imaging features.
CASE SUMMARY In this paper, two patients are reported: One was positive for anti-signal recognition particle antibody, and the other was positive for anti-3-hydroxy-3-methylglutaryl coenzyme A reductase antibody.
CONCLUSION The clinical characteristics and treatment of the two patients were analysed, and the literature was reviewed to improve the recognition, diagnosis, and treatment of this disease.
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Affiliation(s)
- Bi-Hong Chen
- Department of Clinical Medicine, Weifang Medical University, Weifang 261053, Shandong Province, China
| | - Xue-Min Zhu
- School of Clinical Medicine, Weifang Medical University, Weifang 261053, Shandong Province, China
| | - Lei Xie
- School of Clinical Medicine, Weifang Medical University, Weifang 261053, Shandong Province, China
| | - Huai-Qiang Hu
- Department of Neurology, The 960th Hospital of People′s Liberation Army, Jinan 250031, Shandong Province, China
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Iriki J, Yamamoto K, Senju H, Nagaoka A, Yoshida M, Iwasaki K, Ashizawa N, Hirayama T, Tashiro M, Takazono T, Imamura Y, Miyazaki T, Izumikawa K, Yanagihara K, Tsujino A, Fukuoka J, Uetani M, Satoh M, Mukae H. Influenza A (H3N2) infection followed by anti-signal recognition particle antibody-positive necrotizing myopathy: A case report. Int J Infect Dis 2020; 103:33-36. [PMID: 33217572 DOI: 10.1016/j.ijid.2020.11.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 01/13/2023] Open
Abstract
A 60-year-old Japanese woman presented with subacute progressive muscle pain and weakness in her proximal extremities. She was diagnosed with influenza A (H3N2) infection a week before the onset of muscle pain. At the time of admission, she exhibited weakness in the proximal muscles of the upper and lower limbs, elevated serum liver enzymes and creatinine kinase, and myoglobinuria. She did not manifest renal failure and cardiac abnormalities, indicating myocarditis. Electromyography revealed myogenic changes, and magnetic resonance imaging of the upper limb showed abnormal signal intensities in the muscles, suggestive of myopathy. Muscle biopsy of the biceps revealed numerous necrotic regeneration fibers and mild inflammatory cell infiltration, suggesting immune-mediated necrotizing myopathy (IMNM). Necrotized muscle cells were positive for human influenza A (H3N2). Autoantibody analysis showed the presence of antibodies against the signal recognition particle (SRP), and the patient was diagnosed with anti-SRP-associated IMNM. She was resistant to intravenous methylprednisolone pulse therapy but recovered after administration of oral systemic corticosteroids and immunoglobulins. We speculate that the influenza A (H3N2) infection might have triggered her IMNM. Thus, IMNM should be considered as a differential diagnosis in patients with proximal muscle weakness that persists after viral infections.
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Affiliation(s)
- Jun Iriki
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Kazuko Yamamoto
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan; Infection Control and Education Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan.
| | - Hiroaki Senju
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Atsushi Nagaoka
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Masataka Yoshida
- Department of Respiratory Medicine, Sasebo City General Hospital, 9-3 Hirasemachi, Sasebo City, Japan
| | - Keisuke Iwasaki
- Department of Pathology, Sasebo City General Hospital, 9-3 Hirasemachi, Sasebo City, Japan
| | - Nobuyuki Ashizawa
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Tatsuro Hirayama
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Masato Tashiro
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Yoshifumi Imamura
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Taiga Miyazaki
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Koichi Izumikawa
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Masataka Uetani
- Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Minoru Satoh
- Department of Clinical Nursing, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
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Hara A, Amano R, Yokote H, Ijima M, Zeniya S, Uchihara T, Yada S, Masumura M, Takei H, Nishino I, Toru S. Secondary cardiac involvement in anti-SRP-antibody-positive myopathy: an 87-year-old woman with heart failure symptoms as the first clinical presentation. BMC Neurol 2020; 20:29. [PMID: 31952503 PMCID: PMC6969444 DOI: 10.1186/s12883-020-1599-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/02/2020] [Indexed: 12/21/2022] Open
Abstract
Background Necrotizing myopathy (NM) is defined by the dominant pathological feature of necrosis of muscle fibers without substantial lymphocytic inflammatory infiltration. Anti-signal recognition particle (SRP)-antibody-positive myopathy is related to NM. Anti-SRP-antibody-positive myopathy can comorbid with other disorders in some patients, however, comorbidity with malignant tumor and myopericarditis has still not been reported. Case presentation An 87-year-old woman with dyspnea on exertion and leg edema was referred to our hospital because of suspected heart failure and elevated serum creatine kinase level. Upon hospitalization, she developed muscle weakness predominantly in the proximal muscles. Muscle biopsy and immunological blood test led to the diagnosis of anti-SRP-antibody-positive myopathy. A colon carcinoma was also found and surgically removed. The muscle weakness remained despite the tumor resection and treatment with methylprednisolone. Cardiac screening revealed arrhythmia and diastolic dysfunction with pericardial effusion, which recovered with intravenous immunoglobulin (IVIg) treatment. Conclusions We reported the first case of anti-SRP-positive myopathy comorbid with colon carcinoma and myopericarditis. This case is rare in the point that heart failure symptoms were the first clinical presentation. The underlying mechanism is still not clear, however, physicians should be carefully aware of the neoplasm and cardiac involvement in anti-SRP-antibody positive-myopathy patients and should consider farther evaluation and management.
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Affiliation(s)
- Arika Hara
- Department of Neurology, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo Nakano, Tokyo, 164-8607, Japan
| | - Ryota Amano
- Department of Neurology, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo Nakano, Tokyo, 164-8607, Japan.
| | - Hiroaki Yokote
- Department of Neurology, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo Nakano, Tokyo, 164-8607, Japan
| | - Masahide Ijima
- Department of Neurology, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo Nakano, Tokyo, 164-8607, Japan
| | - Satoshi Zeniya
- Department of Neurology, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo Nakano, Tokyo, 164-8607, Japan
| | - Toshiki Uchihara
- Department of Neurology, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo Nakano, Tokyo, 164-8607, Japan
| | - Sawako Yada
- Department of Internal Medicine, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo Nakano, Tokyo, 164-8607, Japan
| | - Mayumi Masumura
- Department of Internal Medicine, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo Nakano, Tokyo, 164-8607, Japan
| | - Hidenobu Takei
- Department of Internal Medicine, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo Nakano, Tokyo, 164-8607, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo, 187-8502, Japan
| | - Shuta Toru
- Department of Neurology, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo Nakano, Tokyo, 164-8607, Japan
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