Abstract
Hydroxyl-methyl-glutaryl-Co-A reductase (HMGCR) immune mediated necrotising myopathy (IMNM) is a rare autoimmune myositis that is thought to be triggered by statins and responds to immunomodulation. We report a case of a woman in her 30s with HMGCR IMNM without a history of statin exposure who had a clear flare of her myositis after beginning mushroom supplements. Mushrooms are natural HMGCR inhibitors, and this is the first case to demonstrate a flare triggered by mushrooms in a patient with known HMGCR IMNM. This case highlights the importance of reviewing diet and supplements in patients with IMNM. It also emphasises the importance of strict statin avoidance for patients with IMNM even when the myositis is under good control.
Keywords:
Drugs: musculoskeletal and joint diseases; Muscle disease.
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MeSH terms
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Adult
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Agaricales*
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Autoantibodies / immunology
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Autoimmune Diseases* / chemically induced
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Autoimmune Diseases* / diagnosis
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Autoimmune Diseases* / immunology
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Autoimmune Diseases* / pathology
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Dietary Supplements* / adverse effects
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Female
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Humans
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Hydroxymethylglutaryl CoA Reductases / adverse effects
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Hydroxymethylglutaryl CoA Reductases / immunology
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Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
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Muscle, Skeletal / immunology
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Muscle, Skeletal / pathology
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Muscular Diseases* / chemically induced
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Muscular Diseases* / diagnosis
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Muscular Diseases* / immunology
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Muscular Diseases* / pathology
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Myositis / chemically induced
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Myositis / diagnosis
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Myositis / immunology
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Myositis / pathology
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Necrosis / chemically induced
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Necrosis / immunology
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Phytotherapy / adverse effects
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Symptom Flare Up
Substances
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Autoantibodies
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Hydroxymethylglutaryl-CoA Reductase Inhibitors
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HMGCR protein, human
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Hydroxymethylglutaryl CoA Reductases