Case ReviewCase of Anti–Single Recognition Particle–Mediated Necrotizing Myopathy After Influenza VaccinationMamarabadi, Mansoureh MD*; Baisre, Ada MD†; Leitch, Megan MD*; Hsu, Vivien MD‡; Kanduri, Jaya S. MD§; Chen, Shan MD, PhD* Author Information *Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; †Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ; ‡Department of Rheumatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; and §Rutgers Robert Wood Johnson Medical School, Piscataway, NJ. Reprints: Shan Chen, MD, PhD, Rutgers Robert Wood Johnson Medical School, 125 Paterson St, 6th Floor, New Brunswick, NJ 08901 (e-mail: [email protected]). The authors report no conflicts of interest. Journal of Clinical Neuromuscular Disease: June 2018 - Volume 19 - Issue 4 - p 211-216 doi: 10.1097/CND.0000000000000208 Buy Metrics Abstract Immune-mediated necrotizing myopathy is a very rare inflammatory disease affecting skeletal muscles. Immune-mediated necrotizing myopathy may be associated with myositis-specific autoantibodies including anti–single recognition particle and anti–3-hydroxy-3- methylglutaryl-coenzyme A reductase, infectious agents (HIV or hepatitis C), other connective tissue disorders (such as scleroderma), and malignancy. We reported a 28-year-old healthy woman presented with subacute onset ascending muscle weakness 2 weeks after an annual influenza vaccination. Cerebral Spinal Fluid study showed normal cell counts with elevated protein and nerve conduction study showed reduced diffuse compound muscle action potential amplitudes suggesting a diagnosis of Guillain–Barré syndrome. Despite treatment using intravenous immunoglobulin, her condition continued to get worse with new bulbar and respiratory muscle weakness. Eventually, the diagnosis of anti–single recognition particle–mediated necrotizing myopathy was made based on elevated creatine kinase, thigh magnetic resonance imaging, muscle biopsy, and positive antibody testing. Our patient responded to the combination of intravenous immunoglobulin, prednisone, and anti-CD20 monoclonal antibody, rituximab. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.