Anti-signal Recognition Particle Antibody-positive Necrotizing Myopathy with Secondary Cardiomyopathy: The First Myocardial Biopsy- and Multimodal Imaging-proven Case

A 69-year-old Japanese woman was admitted to our hospital with progressive muscle weakness and dysphagia. She was taking pitavastatin for dyslipidemia. Her serum creatine kinase was 6,300 U/L. Pitavastatin was stopped, but her symptoms deteriorated, and cardiac congestion appeared. A muscle biopsy showed necrotizing myopathy (NM), and anti-signal recognition particle (SRP) antibody was positive. 18F-fluorodeoxyglucose-positron emission tomography showed an abnormal uptake, and magnetic resonance imaging showed abnormal gadolinium enhancement in the left ventricular wall. An endomyocardial biopsy revealed inflammatory cardiomyopathy. Steroid, tacrolimus, and intravenous immunoglobulins were effective against the symptoms. This is the first case of biopsy-proven secondary cardiomyopathy due to anti-SRP-positive NM.

[1]  I. Nishino,et al.  Integrated Diagnosis Project for Inflammatory Myopathies: An association between autoantibodies and muscle pathology. , 2017, Autoimmunity reviews.

[2]  Christopher A. Miller,et al.  Clinical applications of multi-parametric CMR in myocarditis and systemic inflammatory diseases , 2017, The International Journal of Cardiovascular Imaging.

[3]  Patrizio Lancellotti,et al.  Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. , 2016, European heart journal cardiovascular Imaging.

[4]  J. Baxa,et al.  Imaging of the myocardium using (18)F-FDG-PET/MRI. , 2016, European journal of radiology.

[5]  E. Croteau,et al.  PET Metabolic Biomarkers for Cancer , 2016, Biomarkers in cancer.

[6]  M. Milone,et al.  Clinical Features and Treatment Outcomes of Necrotizing Autoimmune Myopathy. , 2015, JAMA neurology.

[7]  Y. Hayashi,et al.  Inflammatory myopathy with anti-signal recognition particle antibodies: case series of 100 patients , 2015, Orphanet Journal of Rare Diseases.

[8]  E. Aronica,et al.  Review: Immune‐mediated necrotizing myopathies – a heterogeneous group of diseases with specific myopathological features , 2012, Neuropathology and applied neurobiology.

[9]  A. Mammen,et al.  Rituximab therapy for myopathy associated with anti–signal recognition particle antibodies: A case series , 2010, Arthritis care & research.

[10]  B. Engelen,et al.  Anti-signal recognition particle autoantibodies: marker of a necrotising myopathy , 2006, Annals of the rheumatic diseases.

[11]  Timothy A. Miller,et al.  Periodic limb movement syndrome , 2002, Journal of neurology, neurosurgery, and psychiatry.

[12]  M. Dalakas,et al.  A New Approach to the Classification of Idiopathic Inflammatory Myopathy: Myositis‐Specific Autoantibodies Define Useful Homogeneous Patient Groups , 1991, Medicine.

[13]  I. Targoff,et al.  Antibody to signal recognition particle in polymyositis. , 1990, Arthritis and rheumatism.

[14]  MathildeThiébaut,et al.  Antisignal Recognition Particle Antibodies–Related Cardiomyopathy , 2013 .

[15]  C. Oddis,et al.  Anti-signal recognition particle autoantibody in patients with and patients without idiopathic inflammatory myopathy. , 2004, Arthritis and rheumatism.