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Final Program


Final Program

Electrodiagnostic / Neuromuscular Medicine

1506 - Functional Recovery Following Rehabilitation in Statin-Associated Immune-Mediated Necrotizing Myopathy with Positive Anti-Nuclear Matrix Protein 2 Antibody (Anti-NXP2): A Case Report

Thursday, February 19, 2026
5:00 PM - 6:30 PM AST
Case Diagnosis: Severe Immune-Mediated Necrotizing Myopathy (IMNM) with Marked Proximal Weakness.

Case Description: A 73-year-old male with hypertension, hyperlipidemia on high-intensity statin therapy, prior stroke, recent babesiosis, and COVID-19 presented with progressive proximal weakness and myalgias. He was initially treated with atovaquone and azithromycin but subsequently developed worsening weakness and myoglobinuria. Peak creatine kinase was 23,289 IU/L, later declining to 2,206 IU/L with supportive care. Electromyography (EMG) demonstrated a proximal denervating myopathy, and muscle biopsy confirmed immune-mediated necrotizing myopathy (IMNM). The myositis panel was positive for anti-NXP2 antibodies. Atorvastatin was discontinued, and prednisone was initiated. Comprehensive rehabilitation resulted in significant gains in strength, mobility, and independence. An incidental left lower-lobe pulmonary nodule was also identified, with follow-up imaging and pulmonary evaluation arranged.

Discussions:

IMNM is a rare inflammatory myopathy that may be triggered by statin exposure and presents profound proximal weakness and elevated creatine kinase. Anti-NXP2 antibodies, although less common, are associated with severe muscle involvement and greater functional impairment. Early recognition and discontinuation of the statin, along with prompt initiation of steroid therapy, are critical to limiting disease progression. From a rehabilitation perspective, patients with IMNM experience significant functional decline, requiring coordinated multidisciplinary care. Intensive inpatient rehabilitation contributed to measurable improvements in strength, transfers, mobility, and independence with activities of daily living, underscoring the central role of rehabilitation in recovery. Given the association of anti-NXP2–positive IMNM with malignancy in older adults, age-appropriate cancer screening remains an essential component of evaluation and ongoing surveillance.

Conclusions:

This case illustrates the clinical features and management of statin-induced IMNM with positive anti-NXP2 antibodies. Early diagnosis, immunosuppressive therapy, and withdrawal of the offending agent (statin) were essential for disease control. Equally important, structured inpatient rehabilitation provided functional gains, demonstrating that intensive multidisciplinary rehabilitation is integral to optimizing outcomes in IMNM.