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After a repeat presentation with severe weakness, plasmapheresis was commenced, resulting in rapid and significant improvement in muscle strength and biochemical markers, which was sustained for several months. A subsequent disease relapse following discontinuation of regular plasmapheresis responded successfully to a second treatment course of plasmapheresis. The case highlights the potential of plasmapheresis in managing refractory IMNM.<\/jats:p>","DOI":"10.1136\/bcr-2024-262167","type":"journal-article","created":{"date-parts":[[2025,1,19]],"date-time":"2025-01-19T20:50:21Z","timestamp":1737319821000},"page":"e262167","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Therapeutic plasmapheresis as an effective treatment for refractory anti-3-hydroxy-3-methylglutaryl coenzyme A reductase-positive immune-mediated necrotising myopathy"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8029-4949","authenticated-orcid":false,"given":"Andrea","family":"Lyon","sequence":"first","affiliation":[{"name":"Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia"},{"name":"Rheumatology Department, Royal Adelaide Hospital, Adelaide, South Australia, 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