Anti-signal recognition particle immune-mediated necrotising myopathy in an octogenarian

We report a woman in her early 80s who presented with rapidly progressive proximal muscle weakness and functional decline and was diagnosed with anti-signal recognition particle (SRP) immune-mediated necrotising myopathy. Given the recognised aggressive phenotype of anti-SRP-associated disease, she received standard induction and early combination immunosuppressive therapy. Despite appropriate treatment, recovery was limited, with persistent severe weakness and progressive dysphagia, and she died at home 3 months after discharge. This case highlights that in very frail older adults with severe inflammatory myopathy, correct and timely therapy may not translate into meaningful functional recovery, underscoring the prognostic impact of frailty and comorbidity rather than limitations in access to treatment.