Differential diagnosis, investigations, and treatment:
The results of his laboratory tests are in Table 1. His blood tests confirmed an elevated creatine kinase (CK) level, as well as elevations in other muscle enzymes also. A bilateral quadricep muscle magnetic resonance imaging (MRI) study was performed (Figure 1), and an MRI directed muscle biopsy was performed (Figure 2a-c). Based on the muscle enzymes levels, positive 3-hydroxy-3-methylglutaryl-coenzyme A reductase antibody (anti-HMGCR Ab) and the results of the muscle biopsy, he was diagnosed with SANAM.