title: Isolated gluteal and paravertebral muscle weakness due to anti-3-hydroxy-3-methylglutaryl-coenzyme a reductase antibody-associated necrotizing autoimmune myopathy.
abstract: BACKGROUND
  A 56-year-old man with a distant history of statin use presented with progressive isolated very proximal lower limb and truncal weakness. Electromyogram (EMG) showed isolated gluteal and lumbar paraspinal muscle involvement.
  
  
  METHODS
  Gluteus medius muscle biopsy was performed under general anesthesia.
  
  
  RESULTS
  The biopsy showed a pauci-inflammatory necrotizing myopathy. Serum antibodies to 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) were positive. He has since partially responded to corticosteroids and methotrexate.
  
  
  CONCLUSIONS
  Anti-HMGCR-associated necrotizing autoimmune myopathy (NAM) can present in a restricted form after cessation of a statin. Biopsy of a symptomatic but uncommonly studied muscle is worthwhile. Muscle Nerve 54: 150-152, 2016.
authors.affiliation: Department of Medicine, Whangarei Hospital, Private Bag 9742, Whangarei, 0112, New Zealand.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: McGrath
authors.affiliation: Department of Anatomical Pathology, Auckland, New Zealand.
authors.forename: Clinton P
authors.initials: CP
authors.lastname: Turner
keywords: anti-HMGCR immunology; autoimmune; myopathy; necrotizing; proximal weakness