710 - The Benefit of Acute Inpatient Rehabilitation in a Patient with Autoimmune Necrotizing Myopathy: A Case Study

Case Diagnosis: Our patient was a 67-year-old male who presented to an AIR with dysphagia, malnutrition, and impaired mobility ADLs due to autoimmune necrotizing myopathy.  

Case Description: Our patient initially presented to an acute care hospital with difficulty swallowing for several weeks leading to failure to thrive from poor oral intake. During his hospital course the patient had an extensive work up completed by neurology including EMG, which showed evidence of myopathy. Eventually he underwent quadriceps muscle biopsy which confirmed myopathy/mild denervation atrophy consistent with necrotizing autoimmune myopathy. He was also found to have a positive HMG-CoA reductase antibody. After diagnosis was confirmed, the patient presented to AIR with persistent dysphagia on enteral feeds with FIM scores of moderate to total assistance. After undergoing multidisciplinary therapies in an AIR setting for one month, our patient’s FIM scores improved to a supervision level with noted improvement in overall speech clarity, ease of dysphagia exercises, and increased strength numbers on the Iowa Oral Performance Instrument.

Discussions:

While incidence is rare (2-3 per 100,000 of statin users) autoantibodies that target HMGCR can also be found in statin-naïve individuals as well. This is likely the case in our patient as typical presentation is 6 months to 3 years of using statins prior to symptom onset - our patient has not had any change in his statin medications for many years. There are very limited studies showing the benefit of AIR in patients with autoimmune necrotizing myopathy. Moreover, the studies that have been done focus on diagnosis and treatment rather than functional gains after participating in multidisciplinary therapy. 

Conclusions:

Our study demonstrates the significant impact that AIR has on a patient with autoimmune necrotizing myopathy. Further studies should be conducted to corroborate the necessity of multidisciplinary therapies on patient’s who suffer with weakness and dysphagia from this rare disease.