PMC5398416_01
Severe myofiber atrophy with necrosis and myocytolysis not associated with endomysial inflammation. Frozen section (hematoxylin-eosin).
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Prior to the initiation of corticosteroid and rituximab therapy, a muscle biopsy was performed and revealed a pauci-immune necrotizing myopathy with the absence of macrophage infiltration, inclusion bodies and vascular abnormalities (Figure 1).
CK trend over the course of days including when particular treatments were implemented.
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While continuing rituximab a corticosteroid taper was attempted; however, the CK relapsed toward 9000 IU/L, and he subsequently required an increase in corticosteroid dosing (Figure 2).