PM&R Meeting Abstracts

Official abstracts site for the AAPM&R Annual Assembly and the PM&R Journal.

MENU 
  • Home
  • Meetings Archive
    • AAPM&R Annual Assembly 2022
    • AAPM&R Annual Assembly 2021
    • AAPM&R Annual Assembly 2020
    • AAPM&R Annual Assembly 2019
  • Resources
  • Advanced Search

Auto-Antibody Negative Necrotizing Myopathy with Rare Cardiac Involvement and Incorporating Evidence Based Treatment Guidelines

Timothy S. Hake, MD (Ohio State University Hospital PM&R Program, Columbus, Ohio); Mark E. Tornero, MD

Meeting: AAPM&R Annual Assembly 2020

Categories: General Rehabilitation (2020)

Session Information

Session Title: Virtual Poster Hall

Session Time: None. Available on demand.

Disclosures: Timothy S. Hake, MD: No financial relationships or conflicts of interest

Case Description: The patient presented with a 6 month history of progressive proximal weakness with muscle tenderness, dysphagia, and weight loss. Myopathy evaluation notable for elevated creatine kinase, negative anti-3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCR) and anti-signal recognition particle (anti-SRP) antibodies, and chronic latent hepatitis B. Electrodiagnostic studies and muscle biopsy results were consistent with necrotizing myositis. Significant improvements in muscle strength were observed after initiation of immunosuppression with intravenous immunoglobulin, high-dose prednisone, and mycophenolate mofetil. His course was complicated by new palpitations and dyspnea. Cardiac evaluation revealed 1st degree atrioventricular block with trifascicular block and endomyocardial biopsy was consistent with myositis.

Setting: Academic tertiary medical center

Patient: A 45-year-old male with auto-antibody negative necrotizing myopathy with rare cardiac involvement. Assessment/

Results: This patient had functional declines due to delays in cardiac evaluation. With appropriate treatment the patient progressed with functional gains.

Discussion: Immune-mediated necrotizing myopathy (IMNM) can be broken into distinct subtypes – anti-HCGCR myopathy, anti-SRP myopathy, and auto-antibody negative myopathy. Per literature review, cardiac involvement is a rare component of IMNM and is most commonly associated with the anti-SRP subtype. It is uncommon for worsening cardiomyopathy with concurrent improvement in peripheral muscle strength with immunosuppressive therapy. There have been some rare reports of myopathy with chronic hepatitis B infection.

Conclusion: We will review systematic guidelines for appropriate initial management and provide evidence based practice guidelines to optimize a patient’s recovery regarding cardiac complications associated with newly diagnosed immune-mediated necrotizing myopathy.

Level of Evidence: Level V

To cite this abstract in AMA style:

Hake TS, Tornero ME. Auto-Antibody Negative Necrotizing Myopathy with Rare Cardiac Involvement and Incorporating Evidence Based Treatment Guidelines [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/auto-antibody-negative-necrotizing-myopathy-with-rare-cardiac-involvement-and-incorporating-evidence-based-treatment-guidelines/. Accessed June 5, 2025.
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to AAPM&R Annual Assembly 2020

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/auto-antibody-negative-necrotizing-myopathy-with-rare-cardiac-involvement-and-incorporating-evidence-based-treatment-guidelines/

Leading the Way. Baltimore, MD & Virtual. October 20-23, 2022. #aapmr22

PM&R Journal

View issues of PM&R on the Wiley Online Library »

American Academy of Physical Medicine and Rehabilitation

Visit the official site for the American Academy of Physical Medicine and Rehabilitation »

AAPM&R Annual Assembly

Visit the official site for the AAPM&R Annual Assembly »

  • Help & Support
  • About Us
  • Cookies & Privacy
  • Wiley Job Network
  • Terms & Conditions
  • Advertisers & Agents
Copyright © 2025 John Wiley & Sons, Inc. All Rights Reserved.
Wiley