OVERLAP AXONAL POLYNEUROPATHY WITH IMMUNE MEDIATED NECROTISING MYOPATHY
DOI:
https://doi.org/10.55519/JAMC-03-12883Keywords:
Immune mediated necrotisign myopathy, neuromyositis, axonal polyneuropathy, distal muscle weaknessAbstract
Immune mediated necrotising myopathy (IMNM) is a rare autoimmune disease of the muscles belonging to the subset of the idiopathic inflammatory myopathies (IIM). This disease entity has classically been associated with myositis specific antibodies. The hallmark feature in clinching the diagnosis of IMNM would be a muscle biopsy showing muscle necrosis and regeneration in the absence of significant inflammatory infiltrates, interpreted in an appropriate clinical context. The term '˜neuromyositis' was previously coined in the year 1893 to describe a concomitant polyneuropathy in patients with polymyositis or dermatomyositis. However, a combined polyneuropathy with IMNM has never been reported in previous literature. We describe a case of a 35-year-old gentleman who presented with a 5-day history of symmetrical bilateral lower limb pain and weakness. Despite a negative autoimmune work-up, his muscle biopsy was suggestive of IMNM. A nerve conduction study done had also revealed a superimposed non-length dependant axonal polyneuropathy. The patient had responded well to steroids and is now under remission. This case serves to highlight a rare entity of seronegative IMNM superimposed with an axonal polyneuropathy.
References
Malik A, Hayat G, Kalia JS, Guzman MA. Idiopathic inflammatory myopathies: Clinical approach and management. Front Neurol 2016;7:64.
Vattemi G, Mirabella M, Guglielmi V, Lucchini M, Tomelleri G, Ghirardello A, et al. Muscle biopsy features of idiopathic inflammatory myopathies and differential diagnosis. Auto Immun Highlights 2014;5(3):77-85.
Verma R, Paliwal V. Idiopathic inflammatory myopathy: From muscle biopsy to serology. Indian J Rheumatol 2020;15(Suppl 2):S123-30.
Pinal-Fernandez I, Casal-Dominguez M, Mammen AL. Immune-mediated necrotizing myopathy. Curr Rheumatol Rep 2018;20(4):21.
Anim-Koranteng C, Akpoigbe O, Miller M, Averbukh Y. From studio to rehab: A debilitating form of anti-HMGCR myopathy. Cureus 2023;15(6):e40825.
Alenzi F. Myositis specific autoantibodies: A clinical perspective. Open Access Rheumatol 2020;12:9-14.
Park CK, Yoo SJ, Yoo IS, Kim J, Shim SC, Kang SW. Neuromyositis: A rare extramuscular manifestation of dermatomyositis. J Rheum Dis 2019;26(3):211.
Allenbach Y, Benveniste O, Stenzel W, Boyer O. Immune-mediated necrotizing myopathy: clinical features and pathogenesis. Nat Rev Rheumatol 2020;16(12):689-701.
Shepherd S, Batra A, Lerner DP. Review of critical illness myopathy and neuropathy. Neurohospitalist 2017;7(1):41-8.
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