title: Sjögren's syndrome-associated myositis with germinal centre-like structures.
abstract: OBJECTIVE
  Muscular impairment is a rare systemic manifestation of SS that is rarely described in the literature and classically non-specific, both clinically and histologically. We reviewed the cases of 4 patients with primary SS presenting with myositis and a common histologic pattern on muscular biopsy with germinal centre-like structures resembling that which occurs in salivary glands.
  
  
  METHODS
  We analysed the data files of patients with SS who had muscular manifestations and underwent a muscular biopsy. Among 23 patients with SS who had muscle biopsies, 13 had non-specific myositis and 10 (4 primary and 6 secondary SS) had a common histologic pattern consisting of germinal centre-like structures. We analysed the data files of the 4 patients with primary SS presenting with myositis with muscular germinal-centre like structures.
  
  
  RESULTS
  The 4 patients had an unspecific clinical presentation, with myalgias, muscular weakness and normal or elevated values of CPK. In the four patients, SS-associated myositis had common histologic characteristics, with endomysial and perimysial inflammatory infiltrate. The cellular infiltrate was composed predominantly of CD4+ T lymphocytes and B lymphocytes. The B and T CD4+ cells infiltrates may gather into masses, even forming lymphoid follicles. Three patients were treated with corticosteroids and/or hydroxychloroquine with improvement of myositis and 1 patient was lost to follow-up.
  
  
  CONCLUSIONS
  We describe four patients with a common histologic appearance of myositis with lymphoid follicles associated with primary SS. The clinical presentation was non-specific and non-severe, with favorable outcome with corticosteroids and/or hydroxycholoroquine. The discovery of this particular histologic appearance in a muscle biopsy independent of the final diagnosis should indicate the possibility of SS.
authors.affiliation: Service de Médecine Interne, Hôtel-Dieu, CHU de Nantes, 44093 Nantes, France. Electronic address: alexandra.espitiathibault@chu-nantes.fr.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Espitia-Thibault
authors.affiliation: Service de Médecine Interne, Hôtel-Dieu, CHU de Nantes, 44093 Nantes, France.
authors.forename: Agathe
authors.initials: A
authors.lastname: Masseau
authors.affiliation: Service de Médecine Interne, Hôtel-Dieu, CHU de Nantes, 44093 Nantes, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Néel
authors.affiliation: Service de Médecine Interne, Hôtel-Dieu, CHU de Nantes, 44093 Nantes, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Espitia
authors.affiliation: Service d'anatomopathologie, Hôtel-Dieu, CHU de Nantes, 44093 Nantes, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Toquet
authors.affiliation: Service d'anatomopathologie, Hôtel-Dieu, CHU de Nantes, 44093 Nantes, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Mussini
authors.affiliation: Service de Médecine Interne, Hôtel-Dieu, CHU de Nantes, 44093 Nantes, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hamidou
mesh_terms: D000368:Aged; D005260:Female; D018858:Germinal Center / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009220:Myositis / Q000209:etiology*; D012859:Sjogren's Syndrome / Q000150:complications*
keywords: Germinal centre-like structures; Muscular biopsy; Myositis; Sjögren's syndrome