{
  "abstract": "A 68-year-old female presented to the renal clinic with a two-week history of generalised fatigue and myalgia. This was on a background of chronic renal disease, hypertension and dyslipidaemia. She had no associated rash or dyspnoea. The patient was tolerating statin therapy well for more than 5 years.Neurological examination demonstrated normal muscle bulk, tone, and painful proximal muscle weakness involving bilateral thighs and an antalgic gait with right leg drag. The rest of the neurological examination was normal.Investigations demonstrated an abnormally raised CK level (12569 u/L), raised LDH (698 u/L), low eGFR (11 ml/min), abnormal creatinine (340 mmol/L) and urea (13.5 mmol/L). Her serum Anti HMG-CoA antibody was negative. Vasculitis screen, immune serology screen, and infective screen were normal. MRI of bilateral thighs demonstrated widespread STIR hyperintensities suggesting myositis. Hamstring muscle biopsy demonstrated changes consistent with immune-mediated necrotising myositis.Discussion Myopathy is a commonly known side effect of statin use, but the clinical presentation is heterogeneous. Rarely, patients can present with immune-mediated necrotising myositis in the absence of anti-HMG-CoA antibodies. The incidence is 2–3 patients per 100,000 population, 1 and a high clinical suspicion will help investigate and treat this condition effectively.Conclusion Immune-mediated necrotising myositis in patients with chronic statin use will not respond to statin withdrawal and should be aggressively managed with immunosuppression and immunoglobulins.Reference Selva-O’Callaghan A, Alvarado-Cardenas M, Pinal-Fernández I, et al. Statin-induced myalgia and myositis: an update on pathogenesis and clinical recommendations. Expert Rev Clin Immunol. 2018;14(3):215–224. doi:10.1080/1744666X.2018.1440206",
  "authors": [
    {
      "affiliations": [
        "Neurology, Dubbo Base Hospital (WNSWLHD), Dubbo, NSW, Australia",
        "Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia"
      ],
      "name": "Daniel Lowe"
    },
    {
      "affiliations": [
        "Neurology, Canberra Neurology, Canberra, ACT, Australia",
        "Neurology, Dubbo Base Hospital (WNSWLHD), Dubbo, NSW, Australia",
        "Neurology, The Canberra Hospital (CHS), Canberra, ACT, Australia"
      ],
      "name": "Tina Ahluwalia"
    }
  ],
  "title": "3633 Seronegative necrotising myositis: a diagnostic dilemma",
  "uid": "24c17286-273d-51f4-b839-8339b33869cf"
}