Outcome and follow-up:
He was started on Prednisone 60 mg per day (approximately 1 mg/kg), Methotrexate 20 mg weekly, along with folic acid 1 mg daily, with only a modest improvement in his muscle enzymes and weakness initially. His muscle weakness worsened as the prednisone was tapered. He was readmitted to an in-patient rehabilitation facility and his further changes to his medications. He is currently on a combination of Prednisone, Methotrexate and Rituximab with both improvement in his muscle strength and muscle enzymes levels. He has since been discharged and continues out-patient rehabilitation.