The IMNMs are divided into three subtypes: anti-SRP IMNM, anti-HMGCR IMNM, and seronegative IMNM [6]. The overall prevalence of autoimmune myopathies is 9 to 14 cases per 10,000 [7]. This case presents a diagnostically and therapeutically challenging instance of IMNM in an elderly patient with dual positivity for anti-HMGCR and anti-OJ antibodies, further complicated by progressive respiratory failure and severe dysphagia. Here, HMGCR is linked to respiratory failure.