Immune-Mediated Necrotizing Myopathy Initially Presenting as Erythema Nodosum

Shuni Ying; Sheng Li; Shunli Tang; Qingmiao Sun; Deren Fang; Yali Li; Dingxian Zhu; Hong Fang; Jianjun Qiao

doi:10.2147/JIR.S270114

Immune-Mediated Necrotizing Myopathy Initially Presenting as Erythema Nodosum

J Inflamm Res. 2020 Aug 24:13:471-476. doi: 10.2147/JIR.S270114. eCollection 2020.

Authors

Shuni Ying¹, Sheng Li¹, Shunli Tang¹, Qingmiao Sun¹, Deren Fang¹, Yali Li¹, Dingxian Zhu¹, Hong Fang¹, Jianjun Qiao¹

Affiliation

¹ Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China.

Abstract

Immune-mediated necrotizing myopathy (IMNM) is a type of autoimmune myopathy characterized by severe diffuse proximal myofiber necrosis in the context of inflammatory myopathy. Autoantibodies of anti-signal recognition particle and anti-hydroxy-3-methylglutaryl-CoA reductase are two antibodies specific to IMNM. Erythema nodosum (EN) is often accompanied by various systemic diseases, such as autoimmune diseases. Herein, we report a female patient with signal recognition particle-associated IMNM, with EN as the first presentation. She showed significant clinical improvement after the initiation of glucocorticoids, intravenous immunoglobulin, rituximab, and mycophenolate mofetil. This case indicates that IMNM can initially present as EN. IMNM and EN might have overlapping pathogeneses.

Keywords: autoantibody; erythema nodosum; immune-mediated necrotizing myopathy.

Publication types

Case Reports

Grants and funding

This work was supported by the Medical Health Science and Technology Project of Health Commission of Zhejiang Province (2020KY558, 2014KYA061 and 2015KYA092).