SARCOID NEUROMYOPATHY WITH SELECTIVE INVOLVEMENT OF THE INTRAMUSCULARNERVES

A 35-year-old man affected with pulmonary sarcoidosis had a 12-year hi story of fatigue and pain in the limbs, with normal neurological exami nation, except for diffusely absent deep tendon reflexes. Muscle biops y samples showed multiple noncaseating granulomas, most prominent arou nd the intramuscular nerves, with predominance of CD4(+) cells. Intram uscular nerve bundles surrounded by granulomas were immunolabelled wit h laminin alpha 1, alpha 2, beta 1 and gamma 1 chain, and collagen IV. Sural nerve biopsy samples were normal. This patient showed a unique histopathological pattern of sarcoid neuromyopathy characterized by di stribution of granulomas or infiltrating cells around intramuscular ne rve fibers. The clinical picture, restricted to nonspecific symptoms o f fatigue and myalgia, and loss of deep tendon reflexes, correlated we ll with the selective localization of sarcoid lesions in contiguity wi th the intramuscular nerves. To our knowledge, this peculiar clinico-p athological correlation has not been reported previously.