MUSCULAR INVOLVEMENT IN BEHCETS-DISEASE - CASE-REPORT AND REVIEW OF THE LITERATURE

Acute necrotizing myositis is described in a 22-yr-old man with clinic ally diagnosed Behcet's disease. Light microscopic examination reveale d a prominently granulocytic-monocytic infiltration of the muscle with severe necrosis. An infectious (bacterial, fungal or parasitic) etiol ogy could be excluded by specific staining techniques and by immunohis tochemistry. Vascular deposition of immune complexes was detected by d irect immunofluorescence. Electron microscopy revealed severe structur al damage and phagocytosis of muscle fibers. In the endomysium, leukoc ytes and occasional erythrocytes were found. Virus-like particles were not seen. The relevant literature on muscular involvement in Behcet's disease is reviewed. It is suggested that two different stages of inf lammation occur in Behcet's disease. In the acute stage it presents as a granulocytic-monocytic necrotizing reaction developing from a neutr ophil-mediated vasculitis. In the later phase lymphocytic infiltration s predominate. Despite the rare involvement of muscles the diagnosis o f Behcet's disease should be considered particularly in younger patien ts presenting with muscular symptoms like pain and swelling pre-domina ntly of the lower extremities.