• Takumi Tamura, Keisuke Miyajima, Kazuki Watanabe, Kazuki Ito, Fumihiko Kin, Ayako Okazaki, Yasuyo Takashima, Tomoyuki Watanabe, Yoshitaka Kawaguchi, Yasushi Wakabayashi, Hiroaki Miyajima, and Yuichiro Maekawa.
• Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan.
• Intern. Med. 2021 Oct 1; 60 (19): 3113-3119.

AbstractA 41-year-old man was admitted with a chief complaint of dyspnea. Echocardiography showed diffuse severe hypokinesis in the left ventricle. Although his heart failure improved, high creatine kinase levels persisted. A muscle biopsy of the biceps brachii showed necrotic and regenerating fibers along with positive findings for major histocompatibility complex class I and membrane attack complex. He was diagnosed with antibody-negative immune-mediated necrotizing myopathy (IMNM). Steroid therapy was started, but he died due to ventricular fibrillation. Autopsy findings revealed CD68-positive macrophages in the myocardium and quadriceps. To our knowledge, this is the first case of antibody-negative IMNM with cardiac involvement.

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