eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2022-06-19 10 6 180 182 10.12691/ajmcr-10-6-5 AJMCR20221065 article Anuraag Sah 1 Hardik Fichadiya hardikfichadiya@gmail.com 1 Muhammed Atif Masood Noori 1 Arshan Khan 2 Harshil Fichadiya 3 Asnia Latif 3 Maria Khazaei 3 Michael Zaboski 3 Department of Internal Medicine, Rutgers NJMS/ Trinitas Regional Medical Center, Elizabeth, NJ 07202 Department of Internal Medicine, Ascension St John Hospital, Detroit, MI 48236 Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ 07740 Immune-mediated necrotizing myopathy (IMNM) is an inflammatory myopathy characterized by proximal muscle weakness and significantly elevated creatinine kinase levels. IMNM occurs primarily in adults and is usually rapidly progressive in nature. It can be seronegative or associated with antibodies against signal recognition peptide (SRP) or hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR). Scarce and rare cases of Immune-mediated necrotizing myopathy have recently been observed in muscle biopsy of COVID-19 patients with similar histological and clinical features of other IMNM with profound proximal muscle weakness and elevated CPK levels. We present a very interesting case of an atypical presentation of IMNM in the presence of COVID-19 infection. Treatment with Remdesivir and dexamethasone resulted in improvement of her symptoms. http://pubs.sciepub.com/ajmcr/10/6/5/ajmcr-10-6-5.pdf COVID-19 necrotizing myositis rhabdomyolysis breakthrough infection