{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:17:18Z","timestamp":1787019438174,"version":"build-2736575974"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Investigative Medicine High Impact Case Reports"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:p>Immune-mediated necrotizing myopathy (IMNM) is a subtype of inflammatory myopathy that is characterized by proximal muscle weakness, markedly elevated serum creatine kinase, myopathic electromyographic findings, and muscle biopsies revealing necrosis or regeneration with sparse inflammatory infiltrate. IMNM tends to be idiopathic but has been associated with certain medications. This supports the possibility for other pharmacotherapies to induce IMNM\u2014particularly leflunomide. Leflunomide is used in the treatment for rheumatoid arthritis and has been shown to induce autoimmune diseases\u2014including autoimmune hepatitis and polymyositis. After an extensive review of history and workup of muscle weakness, we conclude that leflunomide induced an IMNM in our patient. As this is the first case of leflunomide-induced IMNM, it is important for clinicians to suspect an inflammatory myopathy in the setting of myositis while on leflunomide.<\/jats:p>","DOI":"10.1177\/23247096221150636","type":"journal-article","created":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T07:19:45Z","timestamp":1674199185000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Leflunomide-Induced Immune-Mediated Necrotizing Myopathy in a Patient With Rheumatoid Arthritis: A Case Report"],"prefix":"10.1177","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8143-3331","authenticated-orcid":false,"given":"Dylan Matthew","family":"Salazar","sequence":"first","affiliation":[{"name":"Texas Tech University Health Sciences Center El Paso, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devanshi Narendra","family":"Damani","sequence":"additional","affiliation":[{"name":"Texas Tech University Health Sciences Center El Paso, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piya","family":"Kositangool","sequence":"additional","affiliation":[{"name":"Texas Tech University Health Sciences Center El Paso, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melina Jo","family":"Ortiz","sequence":"additional","affiliation":[{"name":"Texas Tech University Health Sciences Center El Paso, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Lavezo","sequence":"additional","affiliation":[{"name":"Texas Tech University Health Sciences Center El Paso, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma","family":"Dihowm","sequence":"additional","affiliation":[{"name":"Texas Tech University Health Sciences Center El Paso, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,1,20]]},"reference":[{"key":"bibr1-23247096221150636","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2018.2598"},{"key":"bibr2-23247096221150636","doi-asserted-by":"publisher","DOI":"10.1007\/s11926-018-0732-6"},{"key":"bibr3-23247096221150636","doi-asserted-by":"publisher","DOI":"10.3233\/JND-180308"},{"key":"bibr4-23247096221150636","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30254-0"},{"key":"bibr5-23247096221150636","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2018.09.008"},{"key":"bibr6-23247096221150636","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27435"},{"issue":"4","key":"bibr7-23247096221150636","first-page":"257","volume":"37","author":"Villa L","year":"2018","journal-title":"Acta Myol"},{"key":"bibr8-23247096221150636","doi-asserted-by":"publisher","DOI":"10.1097\/RHU.0000000000001664"},{"key":"bibr9-23247096221150636","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-019-04577-3"},{"key":"bibr10-23247096221150636","unstructured":"Leflunomide [package insert]. 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