# Tuberculosis-Induced Immune-Mediated Necrotizing Myopathy: A Challenging Case Scenario in a Non-Endemic Country

## TL;DR

A rare case of immune-mediated muscle disease triggered by tuberculosis is reported in a non-endemic country, highlighting diagnostic and treatment challenges.

## Contribution

This is the first reported case of immune-mediated necrotizing myopathy (IMNM) triggered by active tuberculosis.

## Key findings

- Tuberculosis can trigger immune-mediated necrotizing myopathy (IMNM), a condition previously linked to other infections.
- A multidisciplinary approach was essential for diagnosing and managing TB-induced IMNM in this case.
- The case adds new insights into the complex interplay between tuberculosis and autoimmune muscle diseases.

## Abstract

Background and Clinical Significance: Tuberculosis (TB) poses a significant global health challenge; although low–middle income countries carry the heaviest burden, its diagnosis and treatment can be challenging in any country. The clinical picture can be complex and vary from person to person, with autoimmune complications that can hinder TB diagnosis and treatment. Case Presentation: We report the case of a 38-year-old man from Bangladesh who had recently arrived in Italy through the Balkan route. He presented with TB in the cervical lymph nodes and long-standing chronic myalgias. While a wide range of TB-triggered autoimmune entities can be found in the literature, this case is the first to describe immune-mediated necrotizing myopathy (IMNM) triggered by active TB. Conclusions: IMNM has been previously associated only with other infections like SARS-CoV-2 and Dengue. The successful diagnosis and management of TB-induced IMNM was achieved through a collaborative, multidisciplinary approach involving rheumatologists, immunologists, and infectious diseases specialists, showcasing an innovative treatment strategy and adding new insights into the complexities of TB and IMNM.