title: Immune Mediated Necrotizing Myopathy: a Cause of Isolated Myopathy of Neck Extensor Muscle.
abstract: Immune mediated necrotizing myopathy (IMNM) is a unique form of myositis that is characterized by distinct muscle biopsy features including abundant myofiber necrosis, degeneration, and regeneration with only minimal, if any, inflammation on muscle biopsy. IMNM is clinically similar to idiopathic inflammatory myopathy (IIM); hence, muscle biopsy is essential to diagnose IMNM. Herein we describe a case of neck extensor weakness due to necrotizing myopathy. Isolated weakness of the neck extensor muscles is uncommon in IIM and IMNM. This case describes the diagnostic work-up, treatments utilized, and 2 year follow-up course without involvement of other muscle groups and without progression of neck extensor muscle weakness. Advanced imaging using magnetic resonance imaging (MRI) facilitated the diagnosis by identifying the affected muscles and site for muscle biopsy.
authors: Department of Rheumatology, Marshfield Clinic, Marshfield, Wisconsin, USA sehgal.rahul@marshfieldclinic.org.
authors: Rahul
authors: R
authors: Sehgal
authors: Department of Lab/Pathology, Marshfield Clinic, Marshfield, Wisconsin, USA.
authors: Rafael
authors: R
authors: Medina-Flores
authors: Department of Rheumatology, Marshfield Clinic, Marshfield, Wisconsin, USA.
authors: Ralph
authors: R
authors: Yachoui
authors: Department of Radiology, Marshfield Clinic, Marshfield, Wisconsin, USA.
authors: Charles V
authors: CV
authors: Kenney
mesh_terms: D001706:Biopsy; D006801:Humans; D007249:Inflammation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000503:physiopathology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D009135:Muscular Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000276:immunology*; D009220:Myositis / Q000150:complications* / Q000000981:diagnostic imaging / Q000276:immunology*; D009333:Neck / Q000000981:diagnostic imaging / Q000503:physiopathology; D009336:Necrosis; D017285:Polymyositis / Q000503:physiopathology
keywords: Myositis/diagnosis/therapy; Neck muscles/physiopathology; Neuromuscular diseases; Polymyositis/physiopathology