case_images: PMC11307026_01
case_images: Muscle biopsy showing mild variation in fiber size and scattered necrotic fibers (black arrow).
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case_images: jnd-11-jnd240022-g001
case_images: HLA-ABC expression on some fibers; compatible with necrotising myopathy (Fig. 1). High anti-HMGCR autoantibody level (>200 U/ml, reference value < 20U/Ml) led to the diagnosis of anti-HMGCR myopathy.
case_images: Treatment regime and follow-up with CK level.
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case_images: At the beginning of the COVID19 pandemic, the patient could not get one dose of IVIG and that probably resulted increased CK level at 7049 IU/L without clinical deterioration (Figure 2). IU/L, they gradually decreased to below 1000 IU/L during the combination of IVIg and doubled dose Mtx (Figure 2). In addition, HLA-DR antigen was investigated and it was found the alleles HLA DRB1*08 and DRB1*15.
case_images: T1 weighted images shows fatty atrophy in bilateral bilateral rectus femoris, adductor longus, brevis and magnus muscles, biceps femoris muscles, gluteal muscles sartorius muscles, iliopsoas muscles.
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case_images: PMC11307026_01_jnd-11-jnd240022-g003a.jpg
case_images: jnd-11-jnd240022-g003a
case_images: Short tau inversion recovery (STIR) signal increase was noted in adductor longus and brevis muscles (Fig. 3A, B).