Did Shiitake Mushrooms Induce Immune-Mediated Necrotizing Myopathy?

Conclusion

In summary, we presented a case of an elderly man with statin-naive immune-mediated necrotizing myopathy positive for both anti-HMGCR and anti-SRP autoantibodies. Anti-HMGCR antibody-positive immune-mediated necrotizing myopathy may be associated with exposure to naturally occurring dietary HMGCR inhibitors as well as statins. For successful treatment of anti-HMGCR immune-mediated necrotizing myopathy, both cessation of the offending agent and treatment with glucocorticoids and immuno­suppression are often necessary.

Physicians need to consider not only the patient’s medical and social history, but also their dietary history when evaluating patients suspected to have immune-mediated necrotizing myopathy.

Takeshi Yoshida, MD, Hiroaki Chikazawa, MD, and Yoshitaka Kumon, MD, PhD, all work in the Department of Rheumatology at Chikamori Hospital, Kochi, Japan.

Ichizo Nishino, MD, PhD, is the director of the Department of Neuromuscular Research at the National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan.

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