Immunologic Research

, Volume 65, Issue 1, pp 218–229 | Cite as

Mastitis associated with Sjögren’s syndrome: a series of nine cases

  • Radjiv Goulabchand
  • Assia Hafidi
  • Ingrid Millet
  • Jacques Morel
  • Cédric Lukas
  • Sébastien Humbert
  • Sophie Rivière
  • Christian Gény
  • Christian Jorgensen
  • Alain Le Quellec
  • Hélène Perrochia
  • Philippe Guilpain
Therapeutic Aspects in Autoimmunity


Sjögren’s syndrome is well known to target exocrine glands, especially lacrimal and salivary glands, which share with mammary glands anatomical, histological, and immunological features. Herein, we investigated the mammary involvement in patients with Sjögren’s syndrome and compared the histological findings with minor salivary gland involvement. We reviewed the charts of patients with Sjögren’s syndrome (followed in Montpellier University Hospital, between January 2000 and January 2015), in whom minor salivary gland and mammary tissues were available. Two expert pathologists analysed retrospectively these tissues in order to identify inflammatory patterns. Immunohistochemical stainings were performed to precise leucocyte distribution. Sixteen Sjögren’s syndrome patients with available salivary and breast tissue samples were included. All were women, with a median age of 60.1 ± 11.3 years at Sjögren’s syndrome diagnosis. Mammary biopsy was conducted because of breast symptoms in 6 patients and following imaging screening strategies for breast cancer in 10 patients. Nine patients exhibited an inflammatory breast pattern (lymphocytic infiltrates or duct ectasia), close to minor salivary gland histological findings. Immunohistochemical stainings (n = 5) revealed B and T cell infiltrates within breast tissue, with a higher proportion of T CD4+ cells, but no IgG4-secreting plasma cells were found. This is the first series to describe breast inflammatory patterns in Sjögren’s syndrome. Mastitis is in line with the classical involvement of exocrine glands in this disease. These findings are consistent with the literature data considering Sjögren’s syndrome as an “autoimmune epithelitis”.


Sjögren’s syndrome Mastitis Lymphocytic infiltrates Mammary duct ectasia Epithelial glandular cell 



We owe a special thank to Dr A. Garnier (Pathological laboratory, Montpellier), Pr Jean-Emmanuel Kahn (Internal Medicine, Foch Hospital, Suresnes, France), Pr Marc Michel (Internal medicine department, Mondor Hospital, Crétéil, France), all the Pathological department laboratory technicians (Montpellier Hospital) and A Nadaradjane for their kindly help in this work.

Authors Contribution

Radjiv Goulabchand (RG) and Philippe Guilpain (PG) conceived this study. Radjiv Goulabchand (RG), Assia Hafidi (AH), and Hélène Perrochia (HP) performed the histological analysis and captures. Radjiv Goulabchand (RG), Assia Hafidi (AH), Hélène Perrochia (HP), and Philippe Guilpain (PG) conducted interpretation and analysis. Radjiv Goulabchand (RG), Hélène Perrochia (HP), Assia Hafidi (AH), and Philippe Guilpain (PG) contributed to drafting the manuscript. Philippe Guilpain, Ingrid Millet, Jacques Morel, Cédric Lukas, Sébastien Humbert, Sophie Rivière, Christian Gény, Christian Jorgensen, and Alain Le Quellec have taken part in recruiting patients and collecting data. All authors have taken part in drafting the article or revising it critically for important intellectual content and final approval of the version to be published.

Compliance with ethical standards

Conflict of interest

None of the authors has conflicting financial interests or grant support concerning this topic.


  1. 1.
    Burbelo PD, Ambatipudi K, Alevizos I. Genome-wide association studies in Sjögren’s syndrome: What do the genes tell us about disease pathogenesis? Autoimmun Rev. 2014;13:756–61. doi: 10.1016/j.autrev.2014.02.002.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kivity S, Arango MT, Ehrenfeld M, Tehori O, Shoenfeld Y, Anaya J-M, et al. Infection and autoimmunity in Sjogren’s syndrome: a clinical study and comprehensive review. J Autoimmun. 2014;51:17–22. doi: 10.1016/j.jaut.2014.02.008.CrossRefPubMedGoogle Scholar
  3. 3.
    Boisserie P, Poupard A, Guntz M, Lafargue JP, Boyer J, Joubaud F. Primary biliary cirrhosis, chronic pancreatitis and Gougerot-Sjögren syndrome (apropos of a case). Gastroentérol Clin Biol. 1983;7:641–2.PubMedGoogle Scholar
  4. 4.
    Barreda F, Contardo C, León A, Navarrete J, Figueroa R, Attanasio F. Primary sclerosing cholangitis associated with Sjögren’s syndrome, retroperitoneal fibrosis and chronic pancreatitis. Report of a case. Rev Gastroenterol Perú Órgano Soc Gastroenterol Perú. 1989;9:106–14.Google Scholar
  5. 5.
    Moutsopoulos HM. Sjögren’s syndrome: autoimmune epithelitis. Clin Immunol Immunopathol. 1994;72:162–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Mitsias DI, Kapsogeorgou EK, Moutsopoulos HM. The role of epithelial cells in the initiation and perpetuation of autoimmune lesions: lessons from Sjogren’s syndrome (autoimmune epithelitis). Lupus. 2006;15:255–61.CrossRefPubMedGoogle Scholar
  7. 7.
    Tzioufas AG, Kapsogeorgou EK, Moutsopoulos HM. Pathogenesis of Sjögren’s syndrome: what we know and what we should learn. J Autoimmun. 2012;39:4–8. doi: 10.1016/j.jaut.2012.01.002.CrossRefPubMedGoogle Scholar
  8. 8.
    Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, et al. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61:554–8.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Shiboski SC, Shiboski CH, Criswell LA, Baer AN, Challacombe S, Lanfranchi H, et al. American College of Rheumatology classification criteria for Sjögren’s syndrome: a data-driven, expert consensus approach in the Sjögren’s International Collaborative Clinical Alliance cohort. Arthritis Care Res. 2012;64:475–87.CrossRefGoogle Scholar
  10. 10.
    Lwin KY, Zuccarini O, Sloane JP, Beverley PC. An immunohistological study of leukocyte localization in benign and malignant breast tissue. Int J Cancer J Int Cancer. 1985;36:433–8.CrossRefGoogle Scholar
  11. 11.
    Degnim AC, Brahmbhatt RD, Radisky DC, Hoskin TL, Stallings-Mann M, Laudenschlager M, et al. Immune cell quantitation in normal breast tissue lobules with and without lobulitis. Breast Cancer Res Treat. 2014;144:539–49. doi: 10.1007/s10549-014-2896-8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Adamson TC, Fox RI, Frisman DM, Howell FV. Immunohistologic analysis of lymphoid infiltrates in primary Sjogren’s syndrome using monoclonal antibodies. J Immunol Baltim Md. 1950;1983(130):203–8.Google Scholar
  13. 13.
    Huguet P, Bosch JA, Raventós A, Jacas C, Sanjosé A, Vilardell M. Sjögren’s syndrome: histologic and immunohistochemical study. Ann Méd Interne. 1995;146:233–4.Google Scholar
  14. 14.
    Garnier A. Analyse morphologique des critères diagnostiques du syndrome de Goujerot-Sjögren sur les biopsies de glandes salivaires accessoires: a propos de 90 cas. Faculté de Médecine de Limoges. (1996).Google Scholar
  15. 15.
    Szabo K, Papp G, Dezso B, Zeher M. The histopathology of labial salivary glands in primary Sjögren’s syndrome: focusing on follicular helper T cells in the inflammatory infiltrates. Mediators Inflamm. 2014;. doi: 10.1155/2014/631787.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Development Petherick A. Mother’s milk: a rich opportunity. Nature. 2010;468:S5–7. doi: 10.1038/468S5a.CrossRefGoogle Scholar
  17. 17.
    Collado MC, Laitinen K, Salminen S, Isolauri E. Maternal weight and excessive weight gain during pregnancy modify the immunomodulatory potential of breast milk. Pediatr Res. 2012;72:77–85. doi: 10.1038/pr.2012.42.CrossRefPubMedGoogle Scholar
  18. 18.
    Aitken SL, Corl CM, Sordillo LM. Immunopathology of mastitis: insights into disease recognition and resolution. J Mammary Gland Biol Neoplasia. 2011;16:291–304. doi: 10.1007/s10911-011-9230-4.CrossRefPubMedGoogle Scholar
  19. 19.
    Boullu S, Andrac L, Piana L, Darmon P, Dutour A, Oliver C. Diabetic mastopathy, complication of type 1 diabetes mellitus: report of two cases and a review of the literature. Diabetes Metab. 1998;24:448–54.PubMedGoogle Scholar
  20. 20.
    Kudva YC, Reynolds C, O’Brien T, Powell C, Oberg AL, Crotty TB. “Diabetic mastopathy”, or sclerosing lymphocytic lobulitis, is strongly associated with type 1 diabetes. Diabetes Care. 2002;25:121–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Kinonen C, Gattuso P, Reddy VB. Lupus mastitis: an uncommon complication of systemic or discoid lupus. Am J Surg Pathol. 2010;34:901–6. doi: 10.1097/PAS.0b013e3181da00fb.CrossRefPubMedGoogle Scholar
  22. 22.
    Rosa M, Mohammadi A. Lupus mastitis: a review. Ann Diagn Pathol. 2013;17:230–3. doi: 10.1016/j.anndiagpath.2012.09.003.CrossRefPubMedGoogle Scholar
  23. 23.
    Islam AD, Selmi C, Datta-Mitra A, Sonu R, Chen M, Gershwin ME, et al. The changing faces of IgG4-related disease: clinical manifestations and pathogenesis. Autoimmun Rev. 2015;14:914–22. doi: 10.1016/j.autrev.2015.06.003.CrossRefPubMedGoogle Scholar
  24. 24.
    Vasaitis L. IgG4-related disease: a relatively new concept for clinicians. Eur J Intern Med. 2016;27:1–9. doi: 10.1016/j.ejim.2015.09.022.CrossRefPubMedGoogle Scholar
  25. 25.
    Dite P, Novotny I, Trna J, Sevcikova A. Autoimmune pancreatitis. Best Pract Res Clin Gastroenterol. 2008;22:131–43. doi: 10.1016/j.bpg.2007.10.014.CrossRefPubMedGoogle Scholar
  26. 26.
    Cheuk W, Chan ACL, Lam W-L, Chow S-M, Crowley P, Lloydd R, et al. IgG4-related sclerosing mastitis: description of a new member of the IgG4-related sclerosing diseases. Am J Surg Pathol. 2009;33:1058–64. doi: 10.1097/PAS.0b013e3181998cbe.CrossRefPubMedGoogle Scholar
  27. 27.
    Ogura K, Matsumoto T, Aoki Y, Kitabatake T, Fujisawa M, Kojima K. IgG4-related tumour-forming mastitis with histological appearances of granulomatous lobular mastitis: comparison with other types of tumour-forming mastitis. Histopathology. 2010;57:39–45. doi: 10.1111/j.1365-2559.2010.03581.x.CrossRefPubMedGoogle Scholar
  28. 28.
    Herrera van Oostdam DA, Jaimes Piñón T, Martínez-Martínez MU, Oros-Ovalle C, Aléman-Sánchez N, Abud-Mendoza C. IgG4-related disease, retrospective histopathological diagnosis. Prevalence in an university hospital. Reumatol Clin. 2015;. doi: 10.1016/j.reuma.2014.12.007.PubMedGoogle Scholar
  29. 29.
    Chougule A, Bal A, Das A, Singh G. IgG4 related sclerosing mastitis: expanding the morphological spectrum of IgG4 related diseases. Pathology (Phila). 2015;47:27–33. doi: 10.1097/PAT.0000000000000187.Google Scholar
  30. 30.
    Stappaerts I, Colpaert C, Verbraecken J, Van Marck E, Vermeire P. Granulomatous mastitis as presenting sign of Wegener’s granulomatosis. Acta Clin Belg. 1999;54:207–10.PubMedGoogle Scholar
  31. 31.
    Ladefoged K, Balslev E, Jemec GB. Crohn’s disease presenting as a breast abscess: a case report. J Eur Acad Dermatol Venereol JEADV. 2001;15:343–5.PubMedGoogle Scholar
  32. 32.
    Barczyńska T, Dankiewicz-Fares I, Bilińska-Reszkowska H, Zalewska J, Jeka S. Atypical location of Wegener’s granulomatosis with breast involvement: case report. Ann Acad Med Stetin. 2011;57:70–6.PubMedGoogle Scholar
  33. 33.
    Zujić PV, Grebić D, Valenčić L. Chronic granulomatous inflammation of the breast as a first clinical manifestation of primary sarcoidosis. Breast Care Basel Switz. 2015;10:51–3. doi: 10.1159/000370206.CrossRefGoogle Scholar
  34. 34.
    Rahal RMS, de Freitas-Júnior R, Carlos da Cunha L, Moreira MAR, Rosa VDL, Conde DM. Mammary duct ectasia: an overview. Breast J. 2011;17:694–5. doi: 10.1111/j.1524-4741.2011.01166.x.CrossRefPubMedGoogle Scholar
  35. 35.
    Al-Masad JK. Mammary duct ectasia and periductal mastitis in males. Saudi Med J. 2001;22:1030–3.PubMedGoogle Scholar
  36. 36.
    Gregoir C, Hilliquin P, Acar F, Lessana-Leibowitch M, Renoux M, Menkès CJ. Acute mastitis in rheumatoid polyarthritis with Gougerot-Sjögren syndrome treated with tiopronin (Acadione). Rev Rhum Mal Ostéo Articul. 1991;58:203–6.Google Scholar
  37. 37.
    Valdez R, Thorson J, Finn WG, Schnitzer B, Kleer CG. Lymphocytic mastitis and diabetic mastopathy: a molecular, immunophenotypic, and clinicopathologic evaluation of 11 cases. Mod Pathol. 2003;16:223–8. doi: 10.1097/01.MP.0000056627.21128.74.CrossRefPubMedGoogle Scholar
  38. 38.
    Ríos G, Peredo RA. Lymphocytic mastitis preceding Sjögren’s syndrome. P R Health Sci J. 2010;29:127–9.PubMedGoogle Scholar
  39. 39.
    Chomette G, Auriol M, Labrousse F, Raphaël M, Szpirglas H, Vaillant JM. Immunopathology of the labial salivary glands in Sjögren’s syndrome and other autoimmune diseases. Rev Stomatol Chir Maxillofac. 1988;89:237–41.PubMedGoogle Scholar
  40. 40.
    Talal N, Asofsky R, Lightbody P. Immunoglobulin synthesis by salivary gland lymphoid cells in Sjögren’s syndrome. J Clin Invest. 1970;49:49–54. doi: 10.1172/JCI106221.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Anderson LG, Cummings NA, Asofsky R, Hylton MB, Tarpley TM, Tomasi TB, et al. Salivary gland immunoglobulin and rheumatoid factor synthesis in Sjögren’s syndrome. Natural history and response to treatment. Am J Med. 1972;53:456–63.CrossRefPubMedGoogle Scholar
  42. 42.
    Speight PM, Cruchley A, Williams DM. Quantification of plasma cells in labial salivary glands: increased expression of IgM in Sjögren’s syndrome. J Oral Pathol Med. 1990;19:126–30.CrossRefPubMedGoogle Scholar
  43. 43.
    Matthews JB, Deacon EM, Wilson C, Potts AJ, Hamburger J. Plasma cell populations in labial salivary glands from patients with and without Sjögren’s syndrome. Histopathology. 1993;23:399–407.CrossRefPubMedGoogle Scholar
  44. 44.
    van Woerkom JM, Kruize AA, Barendregt PJ, Kater L, Hené R, Bootsma H, et al. Clinical significance of quantitative immunohistology in labial salivary glands for diagnosing Sjogren’s syndrome. Rheumatol Oxf Engl. 2006;45:470–7. doi: 10.1093/rheumatology/kei191.CrossRefGoogle Scholar
  45. 45.
    Roguedas A-M, Pers J-O, Lemasson G, Devauchelle V, Tobón GJ, Saraux A, et al. Memory B-cell aggregates in skin biopsy are diagnostic for primary Sjögren’s syndrome. J Autoimmun. 2010;35:241–7. doi: 10.1016/j.jaut.2010.06.014.CrossRefPubMedGoogle Scholar
  46. 46.
    Yoshiiwa A, Nabata T, Morimoto S, Sakaguchi K, Yamagata H, Fukuo K, et al. A case of Hashimoto’s thyroiditis associated with renal tubular acidosis, Sjögren syndrome and empty sella syndrome. Nihon Naibunpi Gakkai Zasshi. 1992;68:1215–23.PubMedGoogle Scholar
  47. 47.
    Ashraf VV, Bhasi R, Kumar RP, Girija AS. Primary Sjögren’s syndrome manifesting as multiple cranial neuropathies: MRI findings. Ann Indian Acad Neurol. 2009;12:124–6. doi: 10.4103/0972-2327.53083.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Ebert EC. Gastrointestinal and hepatic manifestations of Sjogren syndrome. J Clin Gastroenterol. 2012;46:25–30. doi: 10.1097/MCG.0b013e3182329d9c.CrossRefPubMedGoogle Scholar
  49. 49.
    Corsiero E, Sutcliffe N, Pitzalis C, Bombardieri M. Accumulation of self-reactive naïve and memory B cell reveals sequential defects in B cell tolerance checkpoints in Sjögren’s syndrome. PLoS ONE. 2014;. doi: 10.1371/journal.pone.0114575.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Jin L, Yu D, Li X, Yu N, Li X, Wang Y, et al. CD4+ CXCR5+ follicular helper T cells in salivary gland promote B cells maturation in patients with primary Sjogren’s syndrome. Int J Clin Exp Pathol. 2014;7:1988–96.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Varin M-M, Guerrier T, Devauchelle-Pensec V, Jamin C, Youinou P, Pers J-O. In Sjögren’s syndrome, B lymphocytes induce epithelial cells of salivary glands into apoptosis through protein kinase C delta activation. Autoimmun Rev. 2012;11:252–8. doi: 10.1016/j.autrev.2011.10.005.CrossRefPubMedGoogle Scholar
  52. 52.
    Routsias JG, Tzioufas AG. Autoimmune response and target autoantigens in Sjogren’s syndrome. Eur J Clin Invest. 2010;40:1026–36. doi: 10.1111/j.1365-2362.2010.02342.x.CrossRefPubMedGoogle Scholar
  53. 53.
    Kyriakidis NC, Kapsogeorgou EK, Tzioufas AG. A comprehensive review of autoantibodies in primary Sjögren’s syndrome: clinical phenotypes and regulatory mechanisms. J Autoimmun. 2014;51:67–74. doi: 10.1016/j.jaut.2013.11.001.CrossRefPubMedGoogle Scholar
  54. 54.
    Gong Y-Z, Nititham J, Taylor K, Miceli-Richard C, Sordet C, Wachsmann D, et al. Differentiation of follicular helper T cells by salivary gland epithelial cells in primary Sjögren’s syndrome. J Autoimmun. 2014;51:57–66. doi: 10.1016/j.jaut.2013.11.003.CrossRefPubMedGoogle Scholar
  55. 55.
    Ittah M, Miceli-Richard C, Eric Gottenberg J-, Lavie F, Lazure T, Ba N, et al. B cell-activating factor of the tumor necrosis factor family (BAFF) is expressed under stimulation by interferon in salivary gland epithelial cells in primary Sjögren’s syndrome. Arthritis Res Ther. 2006;8:R51. doi: 10.1186/ar1912.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Barrera MJ, Bahamondes V, Sepúlveda D, Quest AFG, Castro I, Cortés J, et al. Sjögren’s syndrome and the epithelial target: a comprehensive review. J Autoimmun. 2013;42:7–18. doi: 10.1016/j.jaut.2013.02.001.CrossRefPubMedGoogle Scholar
  57. 57.
    Mostafa S, Seamon V, Azzarolo AM. Influence of sex hormones and genetic predisposition in Sjögren’s syndrome: a new clue to the immunopathogenesis of dry eye disease. Exp Eye Res. 2012;96:88–97. doi: 10.1016/j.exer.2011.12.016.CrossRefPubMedGoogle Scholar
  58. 58.
    Czerwinski S, Mostafa S, Rowan VS, Azzarolo AM. Time course of cytokine upregulation in the lacrimal gland and presence of autoantibodies in a predisposed mouse model of Sjögren’s Syndrome: the influence of sex hormones and genetic background. Exp Eye Res. 2014;128:15–22. doi: 10.1016/j.exer.2014.09.001.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Tsinti M, Kassi E, Korkolopoulou P, Kapsogeorgou E, Moutsatsou P, Patsouris E, et al. Functional estrogen receptors alpha and beta are expressed in normal human salivary gland epithelium and apparently mediate immunomodulatory effects. Eur J Oral Sci. 2009;117:498–505. doi: 10.1111/j.1600-0722.2009.00659.x.CrossRefPubMedGoogle Scholar
  60. 60.
    Manoussakis MN, Tsinti M, Kapsogeorgou EK, Moutsopoulos HM. The salivary gland epithelial cells of patients with primary Sjögren’s syndrome manifest significantly reduced responsiveness to 17β-estradiol. J Autoimmun. 2012;39:64–8. doi: 10.1016/j.jaut.2012.01.005.CrossRefPubMedGoogle Scholar
  61. 61.
    Katsiougiannis S, Tenta R, Skopouli FN. Endoplasmic reticulum stress causes autophagy and apoptosis leading to cellular redistribution of the autoantigens Ro/Sjögren’s syndrome-related antigen A (SSA) and La/SSB in salivary gland epithelial cells. Clin Exp Immunol. 2015;181:244–52. doi: 10.1111/cei.12638.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Kang YK, Jung SY, Qin J, Li C, Tsai SY, Tsai M-J, et al. E2/Estrogen receptor/sjogren syndrome-associated autoantigen relieves coactivator activator-induced G1/S arrest to promote breast tumorigenicity. Mol Cell Biol. 2014;34:1670–81. doi: 10.1128/MCB.01564-13.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Radjiv Goulabchand
    • 1
    • 2
  • Assia Hafidi
    • 2
    • 3
  • Ingrid Millet
    • 2
    • 4
  • Jacques Morel
    • 2
    • 5
  • Cédric Lukas
    • 2
    • 5
  • Sébastien Humbert
    • 1
    • 2
    • 6
  • Sophie Rivière
    • 1
    • 2
  • Christian Gény
    • 7
  • Christian Jorgensen
    • 2
    • 8
    • 9
  • Alain Le Quellec
    • 1
    • 2
  • Hélène Perrochia
    • 2
    • 3
  • Philippe Guilpain
    • 1
    • 2
    • 9
  1. 1.Department of Internal Medicine, Maladies Multi-Organiques, Centre de compétence “maladies systémiques et auto-immunes rares”St Eloi Hospital, CHRU de MontpellierMontpellier Cedex 5France
  2. 2.UFR Médecine (Medical School)Montpellier UniversityMontpellierFrance
  3. 3.Pathology Department, Gui de Chauliac HospitalMontpellier UniversityMontpellierFrance
  4. 4.Medical Imaging Department, Lapeyronie HospitalMontpellier UniversityMontpellierFrance
  5. 5.Rheumatology Department, Lapeyronie HospitalMontpellier UniversityMontpellierFrance
  6. 6.Internal Medicine Department, Jean Minjoz HospitalBesançon UniversityBesançonFrance
  7. 7.Neurology Department, Gui de Chauliac HospitalMontpellier UniversityMontpellierFrance
  8. 8.Clinical Immunology and Osteoarticular Diseases Therapeutic UnitLapeyronie HospitalMontpellierFrance
  9. 9.Inserm U1183St Eloi HospitalMontpellierFrance

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