Enteric myositis

In Crohn's disease, infiltration of the smooth muscle layer with lymphocytes has been found, but no clue as to whether this is part of the Crohn's disease or an autoimmune phenomenon. Acquired myositis has been described in children in a number of reports. Two have presented with functional intestinal obstruction at 1 and 2.5 years of age. In these patients a dense lymphocyte infiltrate mainly of T cells was found along the large and small intestine. Both responded to immuno-suppressive treatment. A further child with similar histological findings but in whom there was clear evidence of an autoimmune process has more recently been described.8 In this patient features were noted that suggested that the intestinal muscle cells themselves were taking part in the inflammatory response. The patient responded to prednisolone, azathioprine and cyclophosphamide, but was dependent upon steroids.

A similar inflammatory cell infiltrate was described in 12 of 27 Bantu children from South Africa who had some sporadic form of an acquired degenerative enteric myopathy (V.V. Smith, personal communication). However, no information was given as to whether the children suffered from other autoimmune diseases or had autoantibodies present. Nor was there information about response to immuno-suppressive treatment.

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