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Localized myositis in Behcet's diseases.

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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.
Cerrahpasa Medical Faculty
University of Istanbul
Istanbul, Turkey
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.
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behcet, localized, myositis, disease
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