{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T19:30:10Z","timestamp":1786563010905,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T00:00:00Z","timestamp":1697068800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T00:00:00Z","timestamp":1697068800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>We describe the case of a 61\u2010year\u2010old woman with anti\u2010signal recognition particle (SRP) antibody\u2010positive immune\u2010mediated necrotizing myopathy (IMNM) who exhibited biopsy\u2010confirmed thrombotic microangiopathy (TMA). The patient developed proximal\u2010dominant muscle weakness and was diagnosed with anti\u2010SRP antibody\u2010positive IMNM based on muscle biopsy results and serological examination. A high\u2010dose corticosteroid prescription was initiated, followed by intravenous methylprednisolone and intravenous immunoglobulin therapy (IVIg). The patient showed IVIg\u2010induced hemolytic anemia with preserved ADAMTS13 activity. Transient oral tacrolimus administration was initiated. Approximately 8\u2009weeks after admission, the serum creatinine levels gradually increased. Renal histological examination revealed TMA, including ischemic changes in the renal tubules, stenosis, and occlusion of the interlobular arteries with fibrinoid necrosis of the afferent arteriolar walls. The arteriolar walls demonstrated an accumulation of C1q and C3c. Myofiber damage in patients with IMNM accounts for the activation of the classical pathway of the complement cascade in the sarcolemma due to antibody deposition. Additionally, a membrane attack complex is observed on capillaries in the muscle tissues of patients with anti\u2010SRP antibody\u2010positive IMNM. Although drug\u2010induced pathomechanisms, such as IVIg and tacrolimus, can trigger the development of TMA, we suggest that the presence of serum anti\u2010SRP antibodies would be implicated in complement\u2010associated kidney vascular damage.<\/jats:p>","DOI":"10.1111\/1756-185x.14942","type":"journal-article","created":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T01:45:06Z","timestamp":1697161506000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Thrombotic microangiopathy in a patient with anti\u2010signal recognition particle antibody\u2010positive immune\u2010mediated necrotizing myopathy"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8865-4097","authenticated-orcid":false,"given":"Kenji","family":"Sakai","sequence":"first","affiliation":[{"name":"Department of Neurology Joetsu General Hospital  Joetsu 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