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Neurological Rehabilitation

A Case Study: Immune-Mediated Necrotizing Myopathy

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 6

    Poster Presenter(s)

  • Min Ju Kim, DO

    Resident
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    Bronx, New York

    • Co-Author(s)

  • MH

    Myrna Hanna, DO

    Resident
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    Bronx, New York

  • Giorgina Giampaolo, MD

    Resident
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    Bronx, New York

  • Elashvili Mery, DO, MD

    Director of stroke rehabilitation service. DIO
    3473534004
    White Plains, New York

Disclosure(s):
Myrna Hanna, DO: No financial relationships to disclose
Giorgina Giampaolo, MD: No financial relationships to disclose
Elashvili Mery, DO, MD: No financial relationships to disclose
Case Diagnosis: We present a case of an 80-year-old female with immune-mediated necrotizing myopathy (IMNM) that was diagnosed in 2017, who was admitted to an inpatient rehab for right centrum semiovale ovale and posterior aspect of right lentiform nuclei stroke.

Case Description or Program Description: Prior to her hospitalization to rehab, the patient had bilateral paraparesis, and imaging revealed severe L3-L4 spinal stenosis causing thecal sac compression, and C6-C7 central disc protrusion causing spinal cord impingement. Neurosurgery recommended conservative management.
Upon arrival at rehab, the patient presented with mild weakness of left extremities, and debility. On day 1, she could not appropriately answer questions secondary to fatigue. After discussing with her rheumatologist, the team concluded to resume her biweekly IVIG treatments throughout the course of the rehabilitation. She received IVIG on day 3 and 17. After her IVIG treatments, she self-reported improvement in weakness, and was able to appropriately respond to questions.

Setting: Inpatient rehabilitation facility

Assessment/Results: After 3.5 weeks of rehabilitation and continued treatment with IVIG, the patient made fair improvement, and was discharged to a subacute rehabilitation facility.

Discussion (relevance): This is an interesting case of a patient with known IMNM who presented with unilateral limb weakness. It was important to recognize that her symptoms were not only from more common causes such as spinal stenosis and recent stroke she had, but from her chronic condition not being managed properly as she was requiring her IVIG treatment.

Conclusions: IMNM is a rare condition, occurring in 2-9 cases per million. It typically presents with progressive, symmetric proximal muscle weakness without extramuscular involvement. Diagnostic labs include anti-Signal Recognition Particle and anti-HMG-CoA Reductase antibodies. Some complications include dysphagia, and cardiopulmonary impairment. Treatment options include IVIG and immunosuppressive drugs. Although rare, it is crucial for physiatrists to understand its presentation, complications and management to maximize the rehabilitation benefits of the patients with IMNM.