933 - A Multidisciplinary Approach to Statin-Induced Immune-Mediated Necrotizing Myositis: Rehabilitation Challenges and Barriers to IVIG Delivery

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Co-Author(s)

CC

Clay Coppinger, DO

Resident Physician
Montefiore/Einstein
Yonkers, New York, United States
JC

John Coppinger, DO

Chair of Osteopathic Principles and Manipulative Medicine
Meritus School of Osteopathic Medicine
Hagarstown, Maryland, United States

Presenting Author(s)

AD

Allison Dell'Orto, BS

Medical Student
Touro College of Osteopathic Medicine
East Islip, New York, United States

Submitter(s)

AD

Allison Dell'Orto, BS

Touro College of Osteopathic Medicine
East Islip, New York, United States

Case Diagnosis: Statin-induced immune-mediated necrotizing myositis (IMNM)

Case Description: A 71-year-old female with multiple comorbidities, on long-term statin therapy, presented with asymmetrical extremity pain that rapidly advanced to severe back spasms. Subsequently, she developed pedal edema, sore throat, and dysphagia. Laboratory studies revealed elevated creatine kinase ( >22,000 U/L), transaminases, and high-sensitivity troponin T, with normal echocardiogram and negative troponin I. MRI, serology, and muscle biopsy confirmed extensive muscular edema, high HMGCR antibodies, and necrotizing myositis with atrophy, respectively. She received pharmacologic treatment, IVIG, and inpatient rehabilitation; however, insurance and cost restraints delayed rehabilitation and required four hospital transfers across three facilities. Through multidisciplinary management, including aggressive rehabilitation, she progressed from maximal assistance for transfers and mobility to supervised assistance for walking, transfers, and basic activities of daily living. Strength gains were seen in all joints except the shoulders, where weakness persisted.

Discussions:
IMNM is a rare autoimmune myopathy characterized by profound proximal muscle weakness that continues despite statin withdrawal. Delay in recognition can result in significant morbidity, including respiratory and bulbar involvement. Rheumatology and physiatry played essential roles in her care. Regarding her IVIG treatment, both her inpatient rehabilitation facility (IRF) and long term acute care (LTAC) were unable to administer IVIG due to cost, necessitating repeated transfer to acute care. Safety and coordination challenges with IVIG can complicate rehabilitation for patients with IMNM, despite its proven role in myositis. This case demonstrates the importance of coordinating rehabilitation with pharmacologic treatment to optimize function and recovery.

Conclusions: Prompt recognition of IMNM in statin users is essential, as early diagnosis allows timely initiation of multidisciplinary treatment with rehabilitation. This case highlights the functional gains achievable with aggressive rehabilitation, while drawing attention to the need for streamlined IVIG access for timely treatment and optimal recovery.