{
  "abstract": "Background: Anti–3‐hydroxy‐3‐methylglutaryl–coenzyme A reductase (anti‐HMGCR) antibody–positive immune‐mediated necrotizing myopathy (IMNM) is a rare autoimmune myopathy characterized by progressive proximal muscle weakness and markedly elevated creatine kinase levels. Although commonly associated with prior statin exposure, statin‐naïve cases and atypical presentations are well described. Patients with idiopathic inflammatory myopathies are also at increased risk for venous thromboembolism (VTE), though data specific to IMNM remain limited.\n\nCase Presentation: An 83‐year‐old man with brief, remote statin exposure presented with progressive proximal muscle weakness and a three‐year history of oropharyngeal dysphagia preceding limb involvement. Laboratory evaluation revealed markedly elevated creatine kinase and transaminases. Anti‐HMGCR antibodies were positive, and muscle biopsy confirmed necrotizing myopathy. During evaluation for occult malignancy, bilateral pulmonary emboli were incidentally identified. The patient required high‐dose corticosteroids, mycophenolate mofetil, and intravenous immunoglobulin for refractory disease. With aggressive immunosuppressive therapy and rehabilitation, he demonstrated substantial clinical recovery at 6 months.\n\nConclusion: This case highlights oropharyngeal dysphagia as an early and, for a prolonged period, isolated manifestation of anti‐HMGCR antibody–positive IMNM; here, it preceded the onset of limb weakness by approximately 3 years. It underscores the importance of comprehensive diagnostic evaluation in patients with unexplained oropharyngeal dysfunction, in whom an inflammatory myopathy may otherwise be overlooked for years. Clinicians should maintain awareness of thrombotic risk in inflammatory myopathies, particularly during active disease. Early recognition and prompt immunosuppressive therapy remain critical to optimize outcomes and prevent irreversible muscle damage.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Family Medicine Mayo Clinic Health System Eau Claire Wisconsin USA mayoclinichealthsystem.org",
    "Department of Rheumatology Mayo Clinic Health System Eau Claire Wisconsin USA mayoclinichealthsystem.org",
    "Department of Hospital Internal Medicine Mayo Clinic Health System Eau Claire Wisconsin USA mayoclinichealthsystem.org",
    "Department of Pulmonary and Critical Care Medicine Mayo Clinic Health System Eau Claire Wisconsin USA mayoclinichealthsystem.org",
    "Department of Neurology Mayo Clinic Rochester Minnesota USA mayo.edu",
    "Department of Radiology Mayo Clinic Health System Eau Claire Wisconsin USA mayoclinichealthsystem.org"
  ],
  "article_type": "case study",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Rohini Kalluri",
      "orcid": "0009-0000-3146-3284"
    },
    {
      "affs": [
        1
      ],
      "name": "Elena Ciofoaia",
      "orcid": "0000-0001-7080-2023"
    },
    {
      "affs": [
        2
      ],
      "name": "Omobolanle Adetimehin"
    },
    {
      "affs": [
        3
      ],
      "name": "Aryan Shiari",
      "orcid": "0000-0002-6707-5029"
    },
    {
      "affs": [
        2
      ],
      "name": "Igor Dumic",
      "orcid": "0000-0002-5312-8812"
    },
    {
      "affs": [
        4
      ],
      "name": "Margherita Milone",
      "orcid": "0000-0002-4338-9007"
    },
    {
      "affs": [
        2
      ],
      "name": "Juan Vera Gomez",
      "orcid": "0009-0002-4824-148X"
    },
    {
      "affs": [
        5
      ],
      "name": "Erik Sviggum"
    },
    {
      "affs": [
        2
      ],
      "name": "Celestine Odenigbo"
    },
    {
      "affs": [
        2
      ],
      "name": "Cristian Madrid",
      "orcid": "0000-0001-6629-9365"
    },
    {
      "affs": [
        2
      ],
      "name": "Charles W. Nordstrom",
      "orcid": "0000-0002-3012-4560"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/22rhyhk4b1zqe.bib",
  "cited_by": 0,
  "doi": "10.1155/crrh/2235175",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13732100/",
  "id": "22rhyhk4b1zqe",
  "issns": [
    "2090-6889",
    "2090-6897"
  ],
  "landing_url": "https://doi.org/10.1155/crrh/2235175",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Article"
    ],
    [
      "heading",
      "Case Report"
    ],
    [
      "openalex",
      "2745|Inflammatory Myopathies and Dermatomyositis"
    ]
  ],
  "openalex": "W7225255204",
  "pdf_url": "https://onlinelibrary.wiley.com/doi/pdfdirect/10.1155/crrh/2235175",
  "pmcid": "PMC13732100",
  "pmid": "42984811",
  "published": "2026-11-03",
  "publisher": "Wiley",
  "ris": "https://research.draconitic.com/paper/22rhyhk4b1zqe.ris",
  "sources": [
    {
      "first_seen": "2026-11-08T12:22:08Z",
      "native_id": "PMC13732100",
      "source": "pmc",
      "url": "https://doi.org/10.1155/crrh/2235175"
    }
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2745|Inflammatory Myopathies and Dermatomyositis",
      "subfield": "general"
    }
  ],
  "title": "Dysphagia as the Initial Manifestation of Anti‐HMGCR Antibody–Positive Immune‐Mediated Necrotizing Myopathy Complicated by Pulmonary Embolism",
  "title_text": "Dysphagia as the Initial Manifestation of Anti‐HMGCR Antibody–Positive Immune‐Mediated Necrotizing Myopathy Complicated by Pulmonary Embolism",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:22:08Z",
  "url": "https://research.draconitic.com/paper/22rhyhk4b1zqe",
  "venue": "Case Reports in Rheumatology",
  "versions": []
}