Anti-SRP and anti-HMGCR co-positivity in immune-mediated necrotizing myopathy with interstitial lung disease : A rare case report
5 affiliations
- 1Department of Pulmonology, Shifa International Hospital, Islamabad, Pakistan
- 2Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan
- 3Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
- 4Department of Medicine, Women Medical and Dental College, Abbottabad, Pakistan
- 5Department of Medicine, Nasrat Bashir Curative Hospital, Kandahar, Afghanistan.
Abstract
Rationale:: Immune-mediated necrotizing myopathy (IMNM) is a rare inflammatory myopathy. Coexisting anti-signal recognition particle (anti-SRP) and anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibodies in statin-naïve patients with interstitial lung disease are exceptionally uncommon.
Patient concerns:: A 55-year-old statin-naïve man presented with progressive proximal muscle weakness, dysphagia, myalgia, significant weight loss, and exertional dyspnea.
Diagnoses:: Serum creatine kinase was 8000 U/L. Anti-SRP, anti-HMGCR, and anti-Ro52 antibodies were positive. Chest computed tomography showed bilateral consolidations and ground-glass opacities suggestive of organizing pneumonia. Pulmonary function tests revealed reduced forced vital capacity (52%) and diffusing capacity for carbon monoxide (48%). Electromyography and muscle biopsy findings supported IMNM.
Interventions:: Treatment included high-dose corticosteroids, mycophenolate mofetil, nutritional support, and rehabilitation.
Outcomes:: After 3 months, muscle strength improved from 3/5 to 4+/5, dysphagia resolved, and weight increased by 5 kg. Creatine kinase decreased to 350 U/L, forced vital capacity improved to 74%, and diffusing capacity for carbon monoxide to 65%. Follow-up high-resolution computed tomography showed pulmonary improvement without fibrosis.
Lessons:: This case highlights the rare coexistence of anti-SRP and anti-HMGCR antibodies in statin-naïve IMNM with interstitial lung disease. Early immunosuppression, nutritional support, and rehabilitation may improve muscular and pulmonary outcomes. Comprehensive respiratory assessment and longitudinal monitoring are essential.
Related
- Disease-related readmission in anti-SRP-positive immune-mediated necrotizing myopathy: Incidence and exploratory associated factors in a retrospective cohort study
- Persistent HyperCKemia Beyond Post-Viral Myositis: A Case of Anti-HMGCR Immune-Mediated Necrotizing Myopathy
- Rare cutaneous manifestations of statin-induced anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase immune-mediated necrotizing myopathy.
- Dysphagia as the Initial Manifestation of Anti‐HMGCR Antibody–Positive Immune‐Mediated Necrotizing Myopathy Complicated by Pulmonary Embolism
- Refractory Anti-HMGCR Necrotizing Myopathy With Progressive Hypercapnic Respiratory Failure Responsive to a JAK Inhibitor.
BibTeX
@article{imran2026antisrp,
title = {{Anti-SRP and anti-HMGCR co-positivity in immune-mediated necrotizing myopathy with interstitial lung disease : A rare case report}},
author = {Muhammad Imran and Muhammad Hassaan Javaid and Zohad Fareh and Maryam Alam Wazir and Kamil Ahmad Kamil},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051232},
url = {https://europepmc.org/article/PMC/PMC13727274},
note = {CC BY},
}
RIS
TY - JOUR
TI - Anti-SRP and anti-HMGCR co-positivity in immune-mediated necrotizing myopathy with interstitial lung disease : A rare case report
AU - Muhammad Imran
AU - Muhammad Hassaan Javaid
AU - Zohad Fareh
AU - Maryam Alam Wazir
AU - Kamil Ahmad Kamil
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051232
UR - https://europepmc.org/article/PMC/PMC13727274
AB - Rationale:: Immune-mediated necrotizing myopathy (IMNM) is a rare inflammatory myopathy. Coexisting anti-signal recognition particle (anti-SRP) and anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibodies in statin-naïve patients with interstitial lung disease are exceptionally uncommon. Patient concerns:: A 55-year-old statin-naïve man presented with progressive proximal muscle weakness, dysphagia, myalgia, significant weight loss, and exertional dyspnea. Diagnoses:: Serum creatine kinase was 8000 U/L. Anti-SRP, anti-HMGCR, and anti-Ro52 antibodies were positive. Chest computed tomography showed bilateral consolidations and ground-glass opacities suggestive of organizing pneumonia. Pulmonary function tests revealed reduced forced vital capacity (52%) and diffusing capacity for carbon monoxide (48%). Electromyography and muscle biopsy findings supported IMNM. Interventions:: Treatment included high-dose corticosteroids, mycophenolate mofetil, nutritional support, and rehabilitation. Outcomes:: After 3 months, muscle strength improved from 3/5 to 4+/5, dysphagia resolved, and weight increased by 5 kg. Creatine kinase decreased to 350 U/L, forced vital capacity improved to 74%, and diffusing capacity for carbon monoxide to 65%. Follow-up high-resolution computed tomography showed pulmonary improvement without fibrosis. Lessons:: This case highlights the rare coexistence of anti-SRP and anti-HMGCR antibodies in statin-naïve IMNM with interstitial lung disease. Early immunosuppression, nutritional support, and rehabilitation may improve muscular and pulmonary outcomes. Comprehensive respiratory assessment and longitudinal monitoring are essential.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -