Letters to the Editor 108 JEADV 2006, 20, 100– 122 © 2005 European Academy of Dermatology and Venereology consistent with a myogenic pattern. In April 2003 the patient gave birth to a premature child at 35 weeks’ ges- tation. In March 2004 she was admitted to our institution for the second time. There was no significant progression of the skin lesions and no deterioration in the general condition. She complained of arthralgia and proximal muscle weakness. CT scans of the chest showed regression of medi- astinal lymphadenopathy. Liver tests were within normal limits. CPK was persistently high. Pathological findings of the brachial biceps muscle biopsy specimen were com- patible with myositis. Oral administration of prednisolone was begun at a dosage of 40 mg/day. Clinical status and the abnormalities of the CPK levels improved rapidly. Abnormalities of immune function as well as autoantibody production are seen in connective tissue diseases, auto- immune hepatitis and sarcoidosis, suggesting a similar immunopathogenic mechanism. 1,2 Throughout the course of the disease the patient was tested several times for the presence of autoantibodies. Finally she was found to be positive for ANA (anti-nuclear antibodies), anti-Ku, ASMA (anti-smooth muscle antibodies), rheumatoid factor and anticardiolipin antibodies. Anti-Ku antibody is found in a wide spectrum of connective tissue diseases including overlap syndromes with SSc and myositis. 3–5 In some cases antibodies to Ku might contribute to the complication of multiple autoimmune diseases. 5,6 A Lis-Swiety,* L Brzezinska-Wcislo, E Pierzchala, D Wcislo-Dziadecka Department of Dermatology, Silesian Medical Academy, Katowice, Poland. *Corresponding author, E-mail: kikderm@slam.katowice.pl References 1 Enzenauer R, West S. Sarcoidosis in autoimmune disease. Semin Arthritis Rheum 1992; 21: 1–17. 2 Youssef W, Tavill A. Connective tissue diseases and the liver. J Clin Gastronenterol 2002; 35: 345–349. 3 Marie I, Levesque H, Tranvouez J et al. Autoimmune hepatitis and systemic sclerosis: a new overlap syndrome? Rheumatology 2001; 40: 102–106. 4 Nitta Y, Maramatsu M. A juvenile case of overlap syndrome of systemic lupus erythematosus and polymyositis, later accompanied by systemic sclerosis with development of anti-Scl-70 and anti-Ku antibodies. Pediatr Dermatol 2000; 17: 381–383. 5 Kamei N, Yamane K, Yamashita Y et al. Anti-Ku antibody-positive scleroderma-dermatomyositis overlap syndrome developing Graves’ disease and immune thrombocytopenic purpura. Int Med 2002; 41: 1199–1203. 6 Mimori T. Clinical significance of anti-Ku autoantibodies – a serologic marker of overlap syndrome? Int Med 2002; 41: 1096–1098. DOI: 10.1111/j.1468-3083.2005.01321.x ? 2005 18 ? LETTER TO THE EDITOR Letter to the Editor Letter to the Editor Multicentric reticulohistiocytosis – a case with minimal articular changes Multicentric reticulohistiocytosis (MR) is a rare systemic disease that belongs to the group of non-Langerhans cell histiocytoses. Since 1937, when this entity was first described, about 200 cases have been published. 1 The disease was named by Goltz and Layman in 1954. 2 A 21-year-old white woman was first seen by us in October 2002. The disease started in 1999 with pain in the elbows, knees, hands and feet joints. After 2.5 years, she developed painful nodules on the elbows as well as on the fingers and ear lobes. Before the final diagnosis was made, the patient was treated by rheumatologists for polyarthralgia. On the helices of both ears, the elbows, and the dorsal and lateral sides of the fingers and knees there were infil- trated nodules measuring 5–10 mm, some soft, others of a hard consistency, painful on palpation, and the skin above them was violaceous–erythematous and oedematous. The cutaneous changes were accompanied by pain in her shoulders, elbows, knees and hands. After 1 month, an incomplete spontaneous clinical regression of the nodules took place and they resulted in ‘empty little bag’ formations of the skin (fig. 1). Routine laboratory analyses were normal. Immunological analyses showed the following values: slightly increased immunoglobulin G (IgG), C3c and immune complexes; normal values for IgA, IgM, C4 and C-reactive protein, rheumatoid factor, Waaler Rose test, and anti-nuclear fig. 2 The patients’ puffy, swollen fingers.