{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:31:01Z","timestamp":1787725861249,"version":"build-2784847793"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>A 65-year-old male with a 3-year history of atorvastatin use presented with progressive proximal muscle weakness, dysphagia, and markedly elevated creatine kinase (2,277\u202fU\/L). Initially misdiagnosed with polymyositis, he deteriorated with severe pneumonia, septicemia, and type I respiratory failure requiring mechanical ventilation. Interleukin-6 rose from 12.83 to 610.9\u202fpg\/mL during sepsis. After confirmation of anti-HMGCR antibody positivity (18 arbitrary units [AU], cutoff &amp;gt;10\u202fAU) via line blot assay, we discontinued methotrexate, maintained methylprednisolone at 40\u202fmg, and initiated intravenous immunoglobulin (IVIG) 0.4\u202fg\/kg\/day for 5\u202fdays with broad-spectrum antibiotics. Within two weeks, proximal muscle strength (MRC scale) improved from 2\/5 to 4\/5, IL-6 normalized to 8.56\u202fpg\/mL, and respiratory failure resolved. This case suggests that IVIG may serve as a safe immunomodulatory bridge in critically ill IMNM patients with severe infections.<\/jats:p>","DOI":"10.3389\/fmed.2026.1920824","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:02:42Z","timestamp":1787724162000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Balancing immunosuppression and infection\u2014intravenous immunoglobulin in anti-HMGCR immune-mediated necrotizing myopathy complicated by severe pneumonia"],"prefix":"10.3389","volume":"13","author":[{"given":"Jing","family":"Fu","sequence":"first","affiliation":[{"name":"First Clinical Medical College, Guizhou University of Traditional Chinese Medicine","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiong","family":"Zhao","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guizhou 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