Granulomatous myositis: pathologic re-evaluation by immunohistochemical analysis of infiltrating mononuclear cells

To characterize the non-caseating granuloma formation in granulomatous myositis, we analyzed infiltrating mononuclear cells in 7 patients including 2 sarcoid patients, using monoclonal antibodies with a modified immunoperoxidase method. All granulomas consisting of epithelioid, infiltrating mononuclear cells and multinucleated giant cells had markedly increased numbers of CD45Ro-positive cells. The infiltrating inflammatory cells were mostly T lymphocytes and macrophages. The majority of T lymphocytes behaved as T helper/inducer subtype, expressing CD4 positivity. Although the ratio of CD4- to CD8-positive cells in the granuloma in muscle biopsies was not significantly different from that in other organs seen in systemic sarcoidosis, T helper/inducer and T suppressor/cytotoxic cells showed some characteristic distributions: CD4-positive cells accumulated in the center of, and CD8-positive cells at the periphery of, the granuloma. The distribution of infiltrating cells did not differ between muscle biopsies from patients with and without systemic sarcoidosis, suggesting that both groups share the same pathogenetic mechanism in granuloma formation.