PMC9871974_01
Histologic section of the skeletal muscle biopsy from the right vastus
lateralis muscle at 100x power. Findings include scattered necrotic fibers
and myophagocytosis (white arrows), regenerative myofibers (black arrow),
and a paucity of inflammatory cells. It is important to note that the
necrotic myofibrils are in different stages of myonecrosis, myophagocytosis,
and regeneration.
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PMC9871974_01_10.1177_23247096221150636-fig1.jpg
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Muscle biopsy of the right vastus lateralis muscle was obtained and showed scattered necrotic fibers, myophagocytosis, regenerative myofibers, and a paucity of inflammatory cells (Figure 1).
Creatine kinase (U/L) levels over time. It is important to note that the
patient's creatine kinase levels eventually normalized, indicating
successful remission of the immune-mediated necrotizing myopathy. Of note,
the patient was hospitalized and treated with 500 mg methylprednisolone
intravenous piggyback every 12 hours and discharged with 60 mg prednisone
orally daily with gradual taper. Methotrexate was initiated at the 4-month
follow-up at 2.5 mg (4 tablets per week) that was subsequently increased to
6 tablets per week.
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Six months status-post discharge, the prednisone dose was gradually tapered by alternating 2.5 mg and 5 mg every other day with a concurrent use of daily methotrexate sodium 2.5 mg (Figure 2).