Thrombotic microangiopathy in a patient with anti-signal recognition particle antibody-positive immune-mediated necrotizing myopathy.
anti-SRP antibody
immune-mediated necrotizing myopathy
intravenous immunoglobulin
renal biopsy
renal failure
tacrolimus
thrombotic microangiopathy
Journal
International journal of rheumatic diseases
ISSN: 1756-185X
Titre abrégé: Int J Rheum Dis
Pays: England
ID NLM: 101474930
Informations de publication
Date de publication:
12 Oct 2023
12 Oct 2023
Historique:
revised:
20
08
2023
received:
10
07
2023
accepted:
04
10
2023
medline:
13
10
2023
pubmed:
13
10
2023
entrez:
13
10
2023
Statut:
aheadofprint
Résumé
We describe the case of a 61-year-old woman with anti-signal recognition particle (SRP) antibody-positive immune-mediated necrotizing myopathy (IMNM) who exhibited biopsy-confirmed thrombotic microangiopathy (TMA). The patient developed proximal-dominant muscle weakness and was diagnosed with anti-SRP antibody-positive IMNM based on muscle biopsy results and serological examination. A high-dose corticosteroid prescription was initiated, followed by intravenous methylprednisolone and intravenous immunoglobulin therapy (IVIg). The patient showed IVIg-induced hemolytic anemia with preserved ADAMTS13 activity. Transient oral tacrolimus administration was initiated. Approximately 8 weeks after admission, the serum creatinine levels gradually increased. Renal histological examination revealed TMA, including ischemic changes in the renal tubules, stenosis, and occlusion of the interlobular arteries with fibrinoid necrosis of the afferent arteriolar walls. The arteriolar walls demonstrated an accumulation of C1q and C3c. Myofiber damage in patients with IMNM accounts for the activation of the classical pathway of the complement cascade in the sarcolemma due to antibody deposition. Additionally, a membrane attack complex is observed on capillaries in the muscle tissues of patients with anti-SRP antibody-positive IMNM. Although drug-induced pathomechanisms, such as IVIg and tacrolimus, can trigger the development of TMA, we suggest that the presence of serum anti-SRP antibodies would be implicated in complement-associated kidney vascular damage.
Identifiants
pubmed: 37828793
doi: 10.1111/1756-185X.14942
doi:
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.
Références
Allenbach Y, Mammen AL, Benveniste O, Stenzel W, Immune-Mediated Necrotizing Myopathies Working Group. 224th ENMC international workshop: Clinico-sero-pathological classification of immune-mediated necrotizing myopathies Zandvoort, The Netherlands, 14-16 October 2016. Neuromuscul Disord. 2018;28(1):87-99.
Yen TH, Lai PC, Chen CC, Hsueh S, Huang JY. Renal involvement in patients with polymyositis and dermatomyositis. Int J Clin Pract. 2005;59(2):188-193.
Couvrat-Desvergnes G, Masseau A, Benveniste O, et al. The spectrum of renal involvement in patients with inflammatory myopathies. Medicine (Baltimore). 2014;93(1):33-41.
Conticini E, Naveen R, Sen P, et al. Renal injury, biomarkers, and myositis, an understudied aspect of disease: prospective study in the MyoCite cohort. Front Med. 2023;10:1127657.
Chua JS, Baelde HJ, Zandbergen M, et al. Complement factor C4d is a common denominator in thrombotic microangiopathy. J Am Soc Nephrol. 2015;26(9):2239-2247.
Allenbach Y, Arouche-Delaperche L, Preusse C, et al. Necrosis in anti-SRP(+) and anti-HMGCR(+) myopathies: role of autoantibodies and complement. Neurology. 2018;90(6):e507-e517.
Bergua C, Chiavelli H, Allenbach Y, et al. In vivo pathogenicity of IgG from patients with anti-SRP or anti-HMGCR autoantibodies in immune-mediated necrotising myopathy. Ann Rheum Dis. 2019;78(1):131-139.
Watanabe Y, Uruha A, Suzuki S, et al. Clinical features and prognosis in anti-SRP and anti-HMGCR necrotising myopathy. J Neurol Neurosurg Psychiatry. 2016;87(10):1038-1044.
Mammen AL, Amato AA, Dimachkie MM, et al. Zilucoplan in immune-mediated necrotising myopathy: a phase 2, randomised, double-blind, placebo-controlled, multicentre trial. Lancet Rheumatol. 2023;5(2):e67-e76.
Zhao Y, Zhang W, Liu Y, Wang Z, Yuan Y. Factors associated with refractory autoimmune necrotizing myopathy with anti-signal recognition particle antibodies. Orphanet J Rare Dis. 2020;15(1):181.
Trimarchi HM, Truong LD, Brennan S, Gonzalez JM, Suki W. FK506-associated thrombotic microangiopathy: report of two cases and review of the literature. Transplantation. 1999;67(4):539-544.
Takeda A, Ohtsuka Y, Horike K, et al. A case of tacrolimus-associated thrombotic microangiopathy after ABO-blood-type-incompatible renal transplantation. Clin Transplant. 2011;Suppl 23:15-18.
Al-Nouri ZL, Reese JA, Terrell DR, Vesely SK, George JN. Drug-induced thrombotic microangiopathy: a systematic review of published reports. Blood. 2015;125(4):616-618.
Pan FF, Hidayati L, Hughes P, Murugasu A, Masterson R. Case report: thrombotic microangiopathy post-intravenous immunoglobulin in the context of BK nephropathy and renal transplantation. Transplant Proc. 2014;46(1):278-280.
Tasaki M, Saito K, Nakagawa Y, et al. Analysis of the prevalence of systemic de novo thrombotic microangiopathy after ABO-incompatible kidney transplantation and the associated risk factors. Int J Urol. 2019;26(12):1128-1137.