Paraneoplastic Anti-3-hydroxy-3-methylglutary-coenzyme A Reductase Antibody-positive Immune-mediated Necrotizing Myopathy in a Patient with Uterine Cancer

Atsushi Mizuma; Maiko Kouchi; Shizuka Netsu; Sachiko Yutani; Ruriko Kitao; Shigeaki Suzuki; Kenya Murata; Eiichiro Nagata; Shunya Takizawa

doi:10.2169/internalmedicine.56.8134

CASE REPORTS

Paraneoplastic Anti-3-hydroxy-3-methylglutary-coenzyme A Reductase Antibody-positive Immune-mediated Necrotizing Myopathy in a Patient with Uterine Cancer

Atsushi Mizuma, Maiko Kouchi, Shizuka Netsu, Sachiko Yutani, Ruriko Kitao, Shigeaki Suzuki, Kenya Murata, Eiichiro Nagata, Shunya Takizawa

Author information

Atsushi Mizuma
Department of Neurology, Tokai University School of Medicine, Japan
Maiko Kouchi
Department of Neurology, Tokai University School of Medicine, Japan
Shizuka Netsu
Department of Neurology, Tokai University School of Medicine, Japan
Sachiko Yutani
Department of Neurology, Tokai University School of Medicine, Japan
Ruriko Kitao
Department of Neurology, National Hakone Hospital, Japan
Shigeaki Suzuki
Department of Neurology, Keio University School of Medicine, Japan
Kenya Murata
Department of Neurology, Wakayama Medical University, Japan
Eiichiro Nagata
Department of Neurology, Tokai University School of Medicine, Japan
Shunya Takizawa
Department of Neurology, Tokai University School of Medicine, Japan

Keywords: immune-mediated necrotizing myopathy, HMGCR, paraneoplastic syndrome, uterine cancer, steroid therapy

JOURNAL OPEN ACCESS

2017 Volume 56 Issue 14 Pages 1915-1918

DOI https://doi.org/10.2169/internalmedicine.56.8134

Details

Abstract

We report the case of a 69-year-old woman with proximal limb muscle weakness, who received post-operative chemotherapy for uterine cancer. Her serum creatinine kinase level was high (10,779 mg/dL) and a muscle biopsy from her left biceps revealed various sizes of muscle fibers accompanied by necrotic and regenerating fibers. She was positive for anti-3 hydroxy-3-methylglutary-coenzyme A reductase (anti-HMGCR) antibodies, but negative for anti-signal recognition particle (anti-SRP) antibodies. She was diagnosed with immune-mediated necrotizing myopathy (IMNM) and treated with prednisolone.

Our findings indicate that not only drug-induced myopathy but also paraneoplastic myopathy can be involved in the pathogenesis of IMNM.

Corresponding author

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