636 LETTERS Localized myositis in Behqet’s disease To the Editor: The report by Dr. Arkin et a1 of a case of Behqet’s disease with myositis (1) appeared at the same time as a report of a similar patient we very briefly mentioned elsewhere (2). However, our patient, unlike Dr. Arkin’s, had local rather than diffuse myositis. A 23-year-old man was referred to our Behqet’s disease outpatient clinic with oral aphthae for 2 months, genital ulcerations for a year, and erythema nodosumlike lesions for 2 years. His most recent complaint was tenderness of the right upper leg. Physical examination revealed marked swelling and tenderness of the lateral portion of the right quadriceps femoris muscle covering a skin area of approximately 10 x 30 cm. The skin overlying the muscle was normal. There was decreased strength of the right quadriceps femoris, but the strength of the left quadriceps as well as that of the remainder of his muscles was intact. Creatine phosphokinase was 5 units (normal = 0-50), SGOT was 4 units (normal = 0-40), and the erythrocyte sedimentation rate was 54 mm/hour with a normal complete blood count. His pathergy reaction (3) was positive and he was a carrier of HLA-B5. A muscle biopsy from the clinically involved area revealed marked muscle fiber degeneration and both mono- and polymorphonuclear cell infiltration, with accentuation at perivascular areas (Figure 1). After 14 months of followup the patient’s myositis had subsided and he did not have any evidence of myositis elsewhere. However, he developed ileofemoral Figure 1. Muscle tissue showing marked muscle fiber degeneration and mono- and polymorphonuclear cell infiltration with accentuation at perivascular areas. thrombophlebitis and subsequent thrombophlebitis of the inferior vena cava-as judged by skin collaterals on his abdomen. He was lost to followup while still being treated for his thrombophlebitis with aspirin and persantin. HASANYAZICI,MD NUKETTUZUNER,MD YALCINTUZUN,MD SABAHATTIN YURDAKUL, MD Cerrahpasa Medical Faculty University of Istanbul Istanbul, Turkey REFERENCES 1. Arkin CR, Rothschild BM, Florendo NT, Popoff N: BehGet’s syndrome with myositis: a case report with pathologic findings. Arthritis Rheum 23:600-604, 1980 2. Yazici H, Tiiziin Y,Pazarli H, Yurdakul S, Yalqin B, Miiftiioglu A: Behqet’s disease as seen in Turkey. Haematologica 65:381-383, 1980 3. Yazici H, Tiiziin Y, Pazarli H, Yalqin B, Yurdakul S, Miiftiioglu A: The combined use of HLA-B5 and the pathergy test as diagnostic markers of Behqet’s disease in Turkey. J Rheumatol7:206-210, 1980 Muscle involvement in Behqet’s disease To the Editor: Recently, Arkin et a1 (1) reported on a patient with Behqet’s disease who manifested myocarditis and a diffuse myositis. The clinical expression of this feature of the disease is quite rare and is surely less common than the central and peripheral neuropathy of Behqet (neuroBehqet). Reported here are our observations concerning muscle involvement in Behqet’s, which proved to be unexpectedly common on a subclinical level. The purpose of the study was to attempt to confirm the presence of the viral-like structures reported by Shishido and Yamanouchi in 1977 (2). Seven unselected and untreated patients with Behqet’s disease (6 men and 1 woman, ages 21-31) were evaluated. Five had no clinical signs or symptoms of neuromuscular disease. Two others had mild muscle weakness, 1 of which additionally had clinical and electrical features of a peripheral polyneuropathy, a recognized feature of Behqet’s disease (3). All patients had normal creatine phosphokinase and aldolase.