From cranes to crutches: the disabling potential of necrotising myopathy

We present a case of a middle-aged man with progressive bilateral proximal muscle weakness. Laboratory studies showed a creatine kinase level of 22 000 units/L and hydroxy-3-methylglutaryl-CoA reductase (HMGCR) antibody IgG of 109 units. Muscle biopsy revealed necrotic fibres undergoing phagocytosis as well as mixed regenerated and atrophic muscle fibres. The diagnosis of HMGCR necrotising myopathy was confirmed, with marked clinical improvement following mycophenolate mofetil and intravenous immunoglobulin therapy.