{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:41:48Z","timestamp":1791268908987,"version":"4.1.0"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2008,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title>Objective:<\/jats:title>\n            <jats:p>To describe the clinical course and steroid responsiveness of a patient with subacute proximal symmetric weakness, very high serum creatine kinase activity, and myopathic pattern with fibrillations in the electromyogram, whose muscle biopsy showed necrotizing myopathy, with practically no inflammation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Case report.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Academic research.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Diagnosis of muscular dystrophy was suggested; nevertheless, steroid treatment was initiated, and the patient recovered and gained normal strength. However, after a few years he stopped treatment, and all symptoms recurred. He developed severe proximal weakness of all limbs. Another biopsy showed similar findings, with no inflammation; still, he responded favorably to steroids and immunosuppressive medications. Currently on a low dose of prednisone and methotrexate, he has no neurological deficit.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion:<\/jats:title>\n            <jats:p>The absence of inflammation in muscle biopsy may lead to misdiagnosis of muscular dystrophy; however, if the clinical impression is that of inflammatory myopathy, an immunomodulatory treatment should be initiated. During the past century, there has been much controversy about the diagnosis of polymyositis (PM). The debate is still ongoing. We present hereby a patient with typical course and clinical features of PM who underwent two muscle biopsies, several years apart, which showed necrotizing myopathy, practically without inflammation, leading to misdiagnosis of muscular dystrophy. This report brings up the dispute regarding the role of muscle biopsy in the diagnosis of PM.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/cnd.0b013e31815e5d4a","type":"journal-article","created":{"date-parts":[[2009,3,5]],"date-time":"2009-03-05T13:16:48Z","timestamp":1236259008000},"page":"341-344","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":15,"title":["Steroid-Responsive Myopathy: Immune-Mediated Necrotizing Myopathy or Polymyositis Without Inflammation?"],"prefix":"10.1097","volume":"9","author":[{"given":"Menachem","family":"Sadeh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Dabby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-2-20240808","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1056\/NEJM197502132920706","article-title":"Polymyositis and dermatomyositis.","volume":"292","author":"Bohan","year":"1975","journal-title":"N Engl J Med"},{"key":"R2-2-20240808","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1002\/ana.410160206","article-title":"Monoclonal antibody analysis of mononuclear cells in myopathies. I: quantitation of subsets according to diagnosis and sites of accumulation and demonstration and counts of muscle fibers invaded by T cells.","volume":"16","author":"Arahata","year":"1984","journal-title":"Ann Neurol"},{"key":"R3-2-20240808","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/0046-8177(89)90128-7","article-title":"Major histocompatibility complex class I antigen expression, immunolocalization of interferon subtypes, and T cell-mediated cytotoxicity in myopathies.","volume":"20","author":"Emslie-Smith","year":"1989","journal-title":"Hum Pathol"},{"key":"R4-2-20240808","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/S0140-6736(03)14368-1","article-title":"Polymyositis and dermatomyositis.","volume":"362","author":"Dalakas","year":"2003","journal-title":"Lancet"},{"key":"R5-2-20240808","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1016\/S0140-6736(03)14863-5","article-title":"Diagnostic criteria for polymyositis and dermatomyositis.","volume":"362","author":"Dalakas","year":"2003","journal-title":"Lancet"},{"key":"R6-2-20240808","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1212\/WNL.61.3.316","article-title":"Polymyositis: an overdiagnosed entity.","volume":"61","author":"van der Meulen","year":"2003","journal-title":"Neurology"},{"key":"R7-2-20240808","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1212\/WNL.50.3.764","article-title":"Paraneoplastic necrotizing myopathy: clinical and pathological features.","volume":"50","author":"Levin","year":"1998","journal-title":"Neurology"},{"key":"R8-2-20240808","first-page":"936","article-title":"Necrotizing myopathy with pipestem capillaries, microvascular deposition of the complement membrane attack complex (MAC), and minimal cellular infiltration.","volume":"4","author":"Emslie-Smith","year":"1991","journal-title":"Neurology"},{"key":"R9-2-20240808","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1007\/s00415-003-1027-y","article-title":"Necrotising myopathy, an unusual presentation of a steroid-responsive myopathy.","volume":"250","author":"Bronner","year":"2003","journal-title":"J Neurol"},{"key":"R10-2-20240808","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1002\/ana.410120415","article-title":"Inflammatory facioscapulohumeral muscular dystrophy and Coats syndrome.","volume":"12","author":"Wulff","year":"1982","journal-title":"Ann Neurol"},{"key":"R11-2-20240808","doi-asserted-by":"crossref","first-page":"2136","DOI":"10.1212\/WNL.57.11.2136","article-title":"Inflammation in dysferlin myopathy: immunohistochemical characterization of 13 patients.","volume":"57","author":"Gallardo","year":"2001","journal-title":"Neurology"},{"key":"R12-2-20240808","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1212\/01.WNL.0000061520.63546.8F","article-title":"GNE mutations causing distal myopathy with rimmed vacuoles with inflammation.","volume":"61","author":"Yabe","year":"2003","journal-title":"Neurology"}],"container-title":["Journal of Clinical Neuromuscular Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00131402-200803000-00002","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T23:20:41Z","timestamp":1723159241000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00131402-200803000-00002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,3]]},"references-count":12,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2008]]}},"URL":"https:\/\/doi.org\/10.1097\/cnd.0b013e31815e5d4a","relation":{},"ISSN":["1522-0443"],"issn-type":[{"value":"1522-0443","type":"print"}],"subject":[],"published":{"date-parts":[[2008,3]]}}}