{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:43:28Z","timestamp":1791931408286,"version":"4.3.4"},"reference-count":16,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,4,28]]},"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:p>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\u20133 out of every 100\u2009000 patients who use statins. Patients typically present with subacute proximal muscle weakness and creatine kinase levels &gt;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.<\/jats:p>","DOI":"10.1136\/bcr-2019-230213","type":"journal-article","created":{"date-parts":[[2019,5,8]],"date-time":"2019-05-08T15:04:37Z","timestamp":1557327877000},"page":"e230213","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Anti-HMGCR myopathy presenting with acute systolic heart failure"],"prefix":"10.1136","volume":"12","author":[{"given":"Mitchell","family":"Pitlick","sequence":"first","affiliation":[{"name":"Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floranne","family":"Ernste","sequence":"additional","affiliation":[{"name":"Rheumatology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,5,8]]},"reference":[{"key":"2025082709144790000_12.5.e230213.1","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1056\/NEJMra1515161","article-title":"Statin-Associated Autoimmune Myopathy","volume":"374","author":"Mammen","year":"2016","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025082709144790000_12.5.e230213.2","doi-asserted-by":"crossref","first-page":"bcr-2017-223870","DOI":"10.1136\/bcr-2017-223870","article-title":"Immune-mediated necrotising myopathy: a rare cause of hyperCKaemia","volume":"2018","author":"Liang","year":"2018","journal-title":"BMJ Case Rep"},{"key":"2025082709144790000_12.5.e230213.3","first-page":"1","article-title":"A case of atorvastatin-associated necrotizing autoimmune myopathy, mimicking idiopathic polymyositis","volume":"2018","author":"Dixit","year":"2018","journal-title":"Case Rep Rheumatol"},{"key":"2025082709144790000_12.5.e230213.4","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1007\/s11606-015-3303-9","article-title":"An unusual case of statin-induced myopathy: anti-HMGCoA necrotizing autoimmune myopathy","volume":"30","author":"Nichols","year":"2015","journal-title":"J Gen Intern Med"},{"key":"2025082709144790000_12.5.e230213.5","doi-asserted-by":"crossref","first-page":"315","DOI":"10.5582\/ddt.2018.01049","article-title":"Necrotizing Autoimmune myopathy: A case report on statin induced rhabdomyolysis requiring immunosuppressive therapy","volume":"12","author":"Kunwar","year":"2018","journal-title":"Drug Discov Ther"},{"key":"2025082709144790000_12.5.e230213.6","first-page":"1","article-title":"When Should a Patient with Statin-Induced Myopathy Be Re-challenged? A Case of Necrotizing Autoimmune Myopathy","volume":"2018","author":"Obreja","year":"2018","journal-title":"Case Rep Rheumatol"},{"key":"2025082709144790000_12.5.e230213.7","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1001\/jamaneurol.2015.1207","article-title":"Clinical Features and Treatment Outcomes of Necrotizing Autoimmune Myopathy","volume":"72","author":"Kassardjian","year":"2015","journal-title":"JAMA Neurol"},{"key":"2025082709144790000_12.5.e230213.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.rdc.2013.10.002"},{"key":"2025082709144790000_12.5.e230213.9","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2016-000291"},{"key":"2025082709144790000_12.5.e230213.10","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kel311"},{"key":"2025082709144790000_12.5.e230213.11","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jns.2015.02.042","article-title":"Statin induced necrotizing autoimmune myopathy","volume":"351","author":"Babu","year":"2015","journal-title":"J Neurol Sci"},{"key":"2025082709144790000_12.5.e230213.12","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1002\/mus.21486","article-title":"Immune-mediated necrotizing myopathy associated with statins","volume":"41","author":"Grable-Esposito","year":"2010","journal-title":"Muscle Nerve"},{"key":"2025082709144790000_12.5.e230213.13","doi-asserted-by":"publisher","DOI":"10.1002\/mus.23854"},{"key":"2025082709144790000_12.5.e230213.14","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3233\/JND-170282","article-title":"Anti-HMGCR Myopathy","volume":"5","author":"Mohassel","year":"2018","journal-title":"J Neuromuscul Dis"},{"key":"2025082709144790000_12.5.e230213.15","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1038\/nrrheum.2018.54","article-title":"Myositis: Are autoantibodies pathogenic in necrotizing myopathy?","volume":"14","author":"Dalakas","year":"2018","journal-title":"Nat Rev Rheumatol"},{"key":"2025082709144790000_12.5.e230213.16","doi-asserted-by":"crossref","first-page":"157","DOI":"10.12691\/ajmcr-6-8-3","article-title":"Rapid progression of heart failure in a patient with idiopathic inflammatory myopathy","volume":"6","author":"Kariyanna","year":"2018","journal-title":"Am J Med Case Rep"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-230213","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:14:55Z","timestamp":1756311295000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-230213"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5]]},"references-count":16,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2019,5,8]]},"published-print":{"date-parts":[[2019,5]]}},"alternative-id":["10.1136\/bcr-2019-230213"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-230213","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5]]}}}