{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:43:11Z","timestamp":1792417391566,"version":"4.4.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"Abstract<\/jats:title>\n \n Background and Objectives:<\/jats:title>\n Necrotizing myopathy (NM) is a rare inflammatory myopathy characterized by prominent necrosis and minimal to absent inflammation, arising from heterogeneous immune- and non-immune-mediated causes. Muscle biopsy aids diagnosis, especially in seronegative cases and those with overlapping presentations, helping to distinguish NM from other idiopathic inflammatory myopathies (IIMs). This tertiary center study examines the myopathologic spectrum in NM, correlating histopathologic findings with clinical features and autoantibody profiles.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We studied the records and biopsies of 77 patients diagnosed with NM between June 2023 and December 2024. Clinical and myositis antibody data were obtained from the records. The biopsies underwent histologic evaluation, including enzyme histochemistry and immunohistochemistry. Descriptive statistics and Chi-square tests (GraphPad Prism 9.5.1) were used to assess features across etiologies.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n This study included 77 patients (median age, 51 years; M:F, 2.4:1) with a mean creatine phosphokinase of 21,230 IU\/L. All presented with acute\/subacute proximal weakness (\n n<\/jats:italic>\n = 77, 100%), while myalgias (\n n<\/jats:italic>\n = 20, 25%) and fever (\n n<\/jats:italic>\n = 17, 22%) were less common. Identified etiologies included statin-associated myopathy (\n n<\/jats:italic>\n = 19, 24.6%), infections (\n n<\/jats:italic>\n = 22, 28.5%), anti-signal recognition particle myopathy (\n n<\/jats:italic>\n = 7, 9%), anti-hydroxy-3-methylglutaryl-coenzyme A reductase myopathy (\n n<\/jats:italic>\n = 4, 5.1%), others (overlap syndromes, alcohol-related myopathy, lipid storage myopathy, etc.), and idiopathic cases (\n n<\/jats:italic>\n = 15, 19.4%). Biopsy findings included scattered necrotic fibers (\n n<\/jats:italic>\n = 48, 62%), groups of necrotic fibers (\n n<\/jats:italic>\n = 29, 37.6%), fiber regeneration (\n n<\/jats:italic>\n = 52, 67.5%), perivascular inflammation (\n n<\/jats:italic>\n = 11, 14.2%), endomysial inflammation (\n n<\/jats:italic>\n = 4, 5.1%), and major histocompatibility complex class I (MHC-I) expression that was diffuse positive (\n n<\/jats:italic>\n = 22, 28.5%), focal positive (\n n<\/jats:italic>\n = 26, 33.7%), or negative (\n n<\/jats:italic>\n = 19, 24.6%). MHC-I expression significantly discriminated among etiologies (\n P<\/jats:italic>\n = 0.0013), unlike patterns of necrosis or inflammation (\n P<\/jats:italic>\n > 0.20).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n NM encompasses diverse immune- and non-immune-mediated causes that share similar biopsy features, distinct from those of other inflammatory myopathies. Accurate diagnosis requires clinicoseropathologic correlation.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/aian.aian_81_26","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:00:47Z","timestamp":1791979247000},"page":"780-787","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Necrotizing Myopathies: A Myopathology Experience from a Single Tertiary Care Center"],"prefix":"10.4103","volume":"29","author":[{"given":"Swetha","family":"Sivakumar","sequence":"first","affiliation":[{"name":"Department of Pathology, Nizam\u2019s Institute of Medical Sciences, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megha","family":"Uppin","sequence":"additional","affiliation":[{"name":"Department of Pathology, Nizam\u2019s Institute of Medical Sciences, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reshma Sultana","family":"Shaik","sequence":"additional","affiliation":[{"name":"Department of Neurology, Nizam\u2019s Institute of Medical Sciences, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkata Surya Subbalaxmi","family":"Malladi","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Nizam\u2019s Institute of Medical Sciences, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sireesha","family":"Yareeda","sequence":"additional","affiliation":[{"name":"Department of Neurology, Nizam\u2019s Institute of Medical Sciences, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afshan","family":"Jabeen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Nizam\u2019s Institute of Medical Sciences, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sree Bhushan","family":"Raju","sequence":"additional","affiliation":[{"name":"Department of Neurology, Nizam\u2019s Institute of Medical Sciences, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muralidhar","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Neurology, Renova Institute of Neurological Sciences, Renova Century Hospital, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"R2-20261019","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1038\/s41584-020-00515-9","article-title":"Immune-mediated necrotizing myopathy: clinical features and pathogenesis","volume":"16","author":"Allenbach","year":"2020","journal-title":"Nat Rev Rheumatol"},{"key":"R3-20261019","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1093\/rheumatology\/kew503","article-title":"Incidence and prevalence of idiopathic inflammatory myopathies in Sweden: A nationwide population-based study","volume":"56","author":"Svensson","year":"2017","journal-title":"Rheumatology (Oxford)"},{"key":"R4-20261019","doi-asserted-by":"crossref","first-page":"3156","DOI":"10.1093\/rheumatology\/kead052","article-title":"The pattern of MHC class I expression in muscle biopsies from patients with myositis and other neuromuscular disorders","volume":"62","author":"Milisenda","year":"2023","journal-title":"Rheumatology (Oxford)"},{"key":"R5-20261019","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1097\/BOR.0000000000000836","article-title":"Differential diagnosis of necrotizing myopathy","volume":"33","author":"Selva-O'Callaghan","year":"2021","journal-title":"Curr Opin Rheumatol"},{"key":"R6-20261019","doi-asserted-by":"crossref","first-page":"64","DOI":"10.14740\/jmc4039","article-title":"Statin-induced immune-mediated necrotizing myopathy resulting in proximal muscle weakness","volume":"14","author":"Abdalla","year":"2023","journal-title":"J Med Cases"},{"key":"R7-20261019","doi-asserted-by":"crossref","first-page":"62","DOI":"10.4103\/aian.AIAN_389_17","article-title":"Necrotizing autoimmune myopathy: Clinicopathologic study from a single tertiary care centre","volume":"21","author":"Ayesha","year":"2018","journal-title":"Ann Indian Acad Neurol"},{"key":"R8-20261019","doi-asserted-by":"crossref","first-page":"483","DOI":"10.2147\/TCRM.S197941","article-title":"Statin-associated autoimmune myopathy: Current perspectives","volume":"16","author":"Tiniakou","year":"2020","journal-title":"Ther Clin Risk Manag"},{"key":"R9-20261019","doi-asserted-by":"crossref","first-page":"63","DOI":"10.5114\/reum.2022.114108","article-title":"Statin-induced necrotizing autoimmune myopathy: A systematic review","volume":"60","author":"Reddy Somagutta","year":"2022","journal-title":"Reumatologia"},{"key":"R10-20261019","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1097\/MD.0000000000000028","article-title":"Anti-HMGCR autoantibodies in European patients with autoimmune necrotizing myopathies: inconstant exposure to statin","volume":"93","author":"Allenbach","year":"2014","journal-title":"Medicine (Baltimore)"},{"key":"R11-20261019","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jocn.2018.08.010","article-title":"Statin-na\u00efve anti-HMGCR antibody-mediated necrotizing myopathy in China","volume":"57","author":"Jiao","year":"2018","journal-title":"J Clin Neurosci"},{"key":"R12-20261019","doi-asserted-by":"crossref","first-page":"1019972","DOI":"10.3389\/fimmu.2022.1019972","article-title":"Anti-SRP immune-mediated necrotizing myopathy: A critical review of current concepts","volume":"13","author":"Ma","year":"2022","journal-title":"Front Immunol"},{"key":"R13-20261019","first-page":"1076","article-title":"Anti-SRP positive immune-mediated necrotic myopathy with two ulnar fingers on the right hand: A case report","volume":"12","author":"Chen","year":"2019","journal-title":"Int J Clin Exp Med"},{"key":"R14-20261019","doi-asserted-by":"crossref","first-page":"e254702","DOI":"10.1136\/bcr-2023-254702","article-title":"Anti-SRP-positive necrotising myopathy concurrent with breast malignancy","volume":"16","author":"Dandasena","year":"2023","journal-title":"BMJ Case Rep"},{"key":"R15-20261019","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10067-014-2512-7","article-title":"Inflammatory myopathy with anti-SRP antibodies: Case series of a South Australian cohort","volume":"34","author":"Basnayake","year":"2015","journal-title":"Clin Rheumatol"},{"key":"R16-20261019","doi-asserted-by":"crossref","first-page":"e464","DOI":"10.1212\/NXI.0000000000000464","article-title":"Granulomatous myositis induced by anti-PD-1 monoclonal antibodies","volume":"5","author":"Uchio","year":"2018","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"R17-20261019","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/s12883-023-03170-1","article-title":"Immune-mediated necrotizing myopathy (NAM) related to SARS-CoV-2 infection: A case report","volume":"23","author":"Ibrahim","year":"2023","journal-title":"BMC Neurol"},{"key":"R18-20261019","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12969-022-00699-2","article-title":"Dengue infection triggered immune mediated necrotizing myopathy in children: A case report and literature review","volume":"20","author":"Mekmangkonthong","year":"2022","journal-title":"Pediatr Rheumatol Online J"},{"key":"R19-20261019","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.ijid.2020.11.153","article-title":"Influenza A (H3N2) infection followed by anti-signal recognition particle antibody-positive necrotizing myopathy: A case report","volume":"103","author":"Iriki","year":"2021","journal-title":"Int J Infect Dis"},{"key":"R20-20261019","doi-asserted-by":"crossref","first-page":"176","DOI":"10.2169\/internalmedicine.39.176","article-title":"Necrotizing myopathy in a patient with chronic hepatitis C virus infection: A case report and a review of the literature","volume":"39","author":"Satoh","year":"2000","journal-title":"Intern Med"},{"key":"R21-20261019","article-title":"Muscle disorders associated with infections","author":"Chimelli","year":"2013","journal-title":"In: Myopathology: A Volume in the Series Major Problemsin Neurology. Wiley"},{"key":"R22-20261019","doi-asserted-by":"crossref","first-page":"207","DOI":"10.35946\/arcr.v38.2.05","article-title":"Alcoholic myopathy: Pathophysiologic mechanisms and clinical implications","volume":"38","author":"Simon","year":"2017","journal-title":"Alcohol Res"},{"issue":"Suppl 1","key":"R23-20261019","article-title":"Acute necrotizing myopathy in a patient with alcoholic liver disease: A rare and severe toxic myopathy","volume":"9","author":"Baloch","year":"2025","journal-title":"Rheumatol Adv Pract"},{"key":"R24-20261019","doi-asserted-by":"crossref","first-page":"e000151","DOI":"10.1136\/bmjsem-2016-000151","article-title":"Exertional rhabdomyolysis: Physiological response or manifestation of an underlying myopathy?","volume":"2","author":"Scalco","year":"2016","journal-title":"BMJ Open Sport Exerc Med"},{"key":"R25-20261019","doi-asserted-by":"crossref","first-page":"991060","DOI":"10.3389\/fneur.2022.991060","article-title":"Lipid storage myopathy due to late-onset multiple acyl-CoA dehydrogenase deficiency with novel mutations in ETFDH: A case report","volume":"13","author":"Tian","year":"2022","journal-title":"Front Neurol"},{"key":"R26-20261019","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/MD.0b013e31827ebba1","article-title":"Correlation of clinicoserologic and pathologic classifications of inflammatory myopathies: Study of 178 cases and guidelines for diagnosis","volume":"92","author":"Fernandez","year":"2013","journal-title":"Medicine (Baltimore)"},{"key":"R27-20261019","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1111\/1756-185X.13559","article-title":"Overlap myositis, a distinct entity beyond primary inflammatory myositis: A retrospective analysis of a large cohort from the REMICAM registry","volume":"22","author":"Nu\u00f1o-Nu\u00f1o","year":"2019","journal-title":"Int J Rheum Dis"},{"key":"R28-20261019","doi-asserted-by":"crossref","first-page":"3411","DOI":"10.1007\/s10067-022-06270-4","article-title":"High prevalence of necrotizing myofibers in adult dermatomyositis muscle biopsies","volume":"41","author":"Caetano","year":"2022","journal-title":"Clin Rheumatol"},{"key":"R29-20261019","first-page":"238","article-title":"High prevalence of necrotising myopathy pattern in muscle biopsies of patients with anti-Jo-1 antisynthetase syndrome","volume":"41","author":"da Silva","year":"2023","journal-title":"Clin Exp Rheumatol"},{"key":"R30-20261019","doi-asserted-by":"crossref","first-page":"102993","DOI":"10.1016\/j.autrev.2021.102993","article-title":"Immune-mediated necrotizing myopathy (IMNM): A myopathological challenge","volume":"21","author":"Merlonghi","year":"2022","journal-title":"Autoimmun Rev"},{"key":"R31-20261019","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s11926-018-0732-6","article-title":"Immune-mediated necrotizing myopathy","volume":"20","author":"Pinal-Fernandez","year":"2018","journal-title":"Curr Rheumatol Rep"},{"key":"R32-20261019","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/j.nmd.2014.06.436","article-title":"An analysis of the sensitivity and specificity of MHC-I and MHC-II immunohistochemical staining in muscle biopsies for the diagnosis of inflammatory myopathies","volume":"24","author":"Rodr\u00edguez Cruz","year":"2014","journal-title":"Neuromuscul Disord"}],"container-title":["Annals of Indian Academy of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aian.aian_81_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:01:32Z","timestamp":1792414892000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aian.aian_81_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":31,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aian.aian_81_26","relation":{},"ISSN":["0972-2327","1998-3549"],"issn-type":[{"value":"0972-2327","type":"print"},{"value":"1998-3549","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-01-22","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-21","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}