[An autopsy case of microscopic polyarteritis nodosa resembling Schoenlein-Henoch purpura].

A 86 year-old woman was re-admitted because of purpura of her upper and lower extremities, abdominal pain and blood stools. Seven weeks previously, she underwent a gastrectomy for gastric cancer. After re-admission, proteinuria and hematuria were noted, and the serum creatinine level increased. Two months, after the onset of purpura, she died of pneumonia. On autopsy examination, fibrinoid vasculitis of acute inflammatory stage (II) at small arteries and/or arterioles in the bladder, rectum, lungs, spleen and crescentic glomerulonephritis without immune deposits were observed. A diagnosis of microscopic polyarteritis nodosa (M-PN) was made based on these clinical and histological findings. M-PN refers to systemic vaculitis with segmental necrotizing glomerulonephritis. However, this condition may be difficult to diagnose because vasculitis such as Scholein-Henoch purpura (SHP) and/or hypersensitivity angitis, diseases in which the small arteries and arteroles are mainly affected, occasionally bears a clinical and histological resemblance to M-PN. Because differential diagnosis from SHP was required, this case provided abundant suggestions with regard to the entity of M-PN.

[A case of Sjögren syndrome associated with sarcoidosis].

A 70 year-old female with a 6-year history of primary Sjögren syndrome was admitted with fever and loss of weight. Examinations such as the lip biopsy reconfirmed the diagnosis of primary Sjögren syndrome. Abdominal CT and gallium scan showed lymphadenopathy in the abdominal cavity, and an exploratory biopsy was done. Lymph nodes and liver biopsy specimens revealed multiple noncaseating granulomata with some Langhans' giant cells, consistent with sarcoidosis. It has been previously proposed that connective tissue disease and sarcoidosis are related in terms of pathogenesis because both diseases share common immunological features and abnormalities in regard to cellular and humoral immunity. Indeed some data in the literature show a striking similarity between the lymphocyte subpopulation in the parotid gland of Sjögren syndrome and the bronchoalveolar lavage fluid of sarcoidosis. However, it is difficult to assume the same pathogenesis for both diseases, because this aspect of the diseases has not been completely clarified. Despite the fact that the two share common immunological features and abnormalities, the coexistence of primary Sjögren syndrome and sarcoidosis has rarely reported.