A Case Report of Immune Mediated Necrotising Myopathy With Myocardial Involvement: A Lesson in Multi-Disciplinary Care

A 62-year-old female was referred to the acute medical unit with a history of progressively worsening mobility, shortness of breath and leg swelling over the last few months. Initial investigations revealed hypoxia with features of decompensated heart failure (HF) and a significantly elevated troponin. The patient developed a rapidly progressive type two respiratory failure (T2RF) over 24 hours requiring non-invasive ventilation (NIV). There was evidence of marked proximal and respiratory muscle weakness and following investigation the patient was diagnosed with anti-signal-recognition-particle immune mediated necrotising myopathy (SRP-IMNM) with myocardial and respiratory involvement. Following the introduction of high dose corticosteroid and further immunosuppression, the patient was discharged well and has had persistent improvement over the subsequent year.