Rheumatologic work up was negative and EMG showed muscle membrane irritability in all muscles tested. A lower extremity MRI showed muscle atrophy with fatty replacement of the gluteus maximus, a pattern characteristic of muscular dystrophy. Left thigh muscle biopsy showed marked fiber type grouping, atrophic and hypertrophic fibers, moderate fibrosis and inflammation also consistent with muscular dystrophy. Decision was made to start treatment with Prednisone. An IVIG trial was also given in an attempt to keep patient ambulatory while myositis panel and muscular dystrophy panel final results were reported. The patient had significant, although short-lived, improvement of muscle weakness after receiving IVIGs. Her clinical response was more suggestive of an autoimmune disease therefore Methotrexate was added to treatment regimen. Finally, LMGD gene sequencing showed variants of uncertain significance and myositis panel was negative. For this reason, anti-HMGCR testing was ordered which was positive (164H). The patient was continued on immunotherapy and serial IVIG treatment and has remained stable without progression of symptoms.