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Chow JL, Lam A, Shelton GD. Progressive increases in creatine kinase activity in an anorexic cat with necrotising myopathy. JFMS Open Rep 2021; 7:20551169211031790. [PMID: 34350026 PMCID: PMC8287364 DOI: 10.1177/20551169211031790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Case summary A 5-year-old castrated male domestic shorthair cat with weight loss and reduced
appetite was evaluated for increased and progressively rising creatine kinase (CK)
activity. The cat had recently been diagnosed with hepatic lipidosis. Muscle biopsy and
histopathology revealed mild myonecrosis and phagocytosis without obvious inflammatory
cell infiltrates. Resolution of necrotising myopathy was observed after a short course
of anti-inflammatory prednisolone and nutritional supplementation. Relevance and novel information This is the first report of a necrotising myopathy in a cat associated with
progressively increasing CK activity and decreased appetite. Anorexia in cats has been
associated with increased CK activity, but an underlying cause of this CK elevation has
only been postulated. Here we document muscle necrosis and muscle stiffness in a cat
with anorexia.
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Affiliation(s)
- Joyce Ly Chow
- Small Animal Specialist Hospital, Sydney, NSW, Australia
| | - Amy Lam
- Small Animal Specialist Hospital, Sydney, NSW, Australia
| | - G Diane Shelton
- Department of Pathology, School of Medicine, University of California San Diego, La Jolla, CA, USA
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Ying S, Li S, Tang S, Sun Q, Fang D, Li Y, Zhu D, Fang H, Qiao J. Immune-Mediated Necrotizing Myopathy Initially Presenting as Erythema Nodosum. J Inflamm Res 2020; 13:471-476. [PMID: 32922062 PMCID: PMC7457844 DOI: 10.2147/jir.s270114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/11/2020] [Indexed: 01/01/2023] Open
Abstract
Immune-mediated necrotizing myopathy (IMNM) is a type of autoimmune myopathy characterized by severe diffuse proximal myofiber necrosis in the context of inflammatory myopathy. Autoantibodies of anti-signal recognition particle and anti-hydroxy-3-methylglutaryl-CoA reductase are two antibodies specific to IMNM. Erythema nodosum (EN) is often accompanied by various systemic diseases, such as autoimmune diseases. Herein, we report a female patient with signal recognition particle-associated IMNM, with EN as the first presentation. She showed significant clinical improvement after the initiation of glucocorticoids, intravenous immunoglobulin, rituximab, and mycophenolate mofetil. This case indicates that IMNM can initially present as EN. IMNM and EN might have overlapping pathogeneses.
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Affiliation(s)
- Shuni Ying
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | - Sheng Li
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | - Shunli Tang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | - Qingmiao Sun
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | - Deren Fang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | - Yali Li
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | - Dingxian Zhu
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | - Hong Fang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
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Pitlick M, Ernste F. Anti-HMGCR myopathy presenting with acute systolic heart failure. BMJ Case Rep 2019; 12:12/5/e230213. [PMID: 31068355 PMCID: PMC6506079 DOI: 10.1136/bcr-2019-230213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Necrotising autoimmune myopathy (NAM) is an immune-mediated myopathy that may be associated with statin use, malignancy or an autoimmune connective tissue disease, but it can also be idiopathic. Anti-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) myopathy is an extremely rare side effect of statin use, occurring in approximately 2-3 out of every 100 000 patients who use statins. Patients typically present with subacute proximal muscle weakness and creatine kinase levels >10 times the upper limit of normal. The diagnosis is suggested by muscle biopsy showing necrotic fibres with minimal inflammation along with positive anti-HMGCR antibodies. Treatment nearly always requires multiple immunosuppressive agents, the earlier use of which is associated with improved outcomes. Reports of statin-induced NAM leading to heart failure are limited. We present the case of a 69-year-old woman with statin-induced NAM who presented with acute systolic heart failure. Early initiation of high-dose corticosteroids and IVIG resulted in significant improvement in her symptoms.
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