In Reply We read with interest the letter from Dr Dalakas, who expresses certain criticisms of our study.1 We agree that the term clinically significant MHC I expression may be confusing. A score of 1 meant individual scattered fibers showed MHC I on the sarcolemma, which we agree can be seen in other conditions as well, mainly on the sarcoplasm (regenerating fibers). Therefore, only scores greater than 1 were counted as clinically significant in our study.1 As always, if we make a morphological diagnosis of myositis, we do not rely on a single parameter but rather use a combination of them and add autoantibody profiles as well as clinical parameters to achieve a clinical diagnosis of myositis.2 Here, the situation was obviously different, since it was a postmortem analysis with limited possibilities for clinical assessment.
Aschman T, Goebel H, Stenzel WP. Unconvincing Evidence of SARS-CoV-2–Associated Myositis in Autopsied Muscles—Reply. JAMA Neurol. 2022;79(1):92–93. doi:10.1001/jamaneurol.2021.4339
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