{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:20:49Z","timestamp":1787761249984,"version":"build-2784847793"},"reference-count":12,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,8,31]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p>Subacute symmetrical proximal muscle weakness and persistent elevated creatine kinase levels are typical of immune-mediated necrotising myopathy (IMNM). These conditions are accompanied by copious myofibre necrosis, degeneration and regeneration with minimal to no inflammation on muscle biopsy. We report two cases (case 1 and case 2) of asymptomatic IMNM from different families with hyperCKaemia associated with positive anti-signal recognition particle (SRP) and anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies, respectively, and we also reviewed the literature. There are only a few previous descriptions of patients with asymptomatic IMNM.The disease onset could be insidious and lead to delayed diagnosis and treatment. We recommend testing for the anti-HMGCR and anti-SRP antibodies in patients with idiopathic hyperCKaemia because they could show no symptoms of this disorder.<\/jats:p>","DOI":"10.1136\/bcr-2020-235457","type":"journal-article","created":{"date-parts":[[2020,10,8]],"date-time":"2020-10-08T17:15:19Z","timestamp":1602177319000},"page":"e235457","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Immune-mediated necrotising myopathy in asymptomatic patients with high creatine kinase"],"prefix":"10.1136","volume":"13","author":[{"given":"Izadora Fonseca Zaiden","family":"Soares","sequence":"first","affiliation":[{"name":"Neurosciences, Centro Universit\u00e1rio Sa\u00fade ABC, Santo Andre, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria Fernandez","family":"Comprido","sequence":"additional","affiliation":[{"name":"Neurosciences, Centro Universit\u00e1rio Sa\u00fade ABC, Santo Andre, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca Raquel Ruoh Harn Scovoli","family":"Hsu","sequence":"additional","affiliation":[{"name":"Neurosciences, Centro Universit\u00e1rio Sa\u00fade ABC, Santo Andre, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5485-7937","authenticated-orcid":false,"given":"Alzira","family":"Alves de Siqueira Carvalho","sequence":"additional","affiliation":[{"name":"Neurosciences, Centro Universit\u00e1rio Sa\u00fade ABC, Santo Andre, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,10,8]]},"reference":[{"key":"2025082700353512000_13.10.e235457.1","doi-asserted-by":"crossref","DOI":"10.1007\/s11926-015-0548-6","article-title":"Immune-Mediated necrotizing myopathy: update on diagnosis and management","volume":"17","author":"Basharat","year":"2015","journal-title":"Curr Rheumatol Rep"},{"key":"2025082700353512000_13.10.e235457.2","doi-asserted-by":"crossref","first-page":"903","DOI":"10.2147\/TCRM.S162931","article-title":"Myopathy due to HMGCR antibodies in adult mimicking muscular dystrophy associated with cancer and statin exposure - 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