http://brain.oupjournals.org/cgi/content/abstract/124/9/1821
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Brain,
Vol. 124, No. 9, 1821-1831, September 2001
© 2001 Oxford
University Press
Macrophagic myofasciitis lesions assess long-term persistence of
vaccine-derived aluminium hydroxide in muscle
1 Equipe mixte INSERM E 0011/Université Paris XII (`Système
neuromusculaire et inflammation'), Groupe Nerf–Muscle, Département de
Pathologie, Hôpital Henri Mondor de l'Assistance Publique-Hôpitaux de Paris,
Créteil 2 Unité de Myopathologie, Département d'Anatomie
Pathologique, Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin,
Bordeaux 3 Service de Médecine Interne, Groupe Hospitalier
Pitié-Salpêtrière and 4 Service de Microbiologie, Hôpital Européen
Georges Pompidou, Paris, 5 Centre d'Etudes Nucléaires de
Bordeaux-Gradignan (URA 5797 du CNRS), Le Haut Vigneau, Université Bordeaux 1,
Gradignan and 6 Laboratoire de Biopathologie Nerveuse et Musculaire
(JE 2053, Université Aix-Marseille II), Faculté de Médecine, Marseille, France.
Correspondence to: R.K. Gherardi (INSERM EI
0011), Département de Pathologie, Hôpital Henri Mondor, F-94010 Créteil Cedex,
France E-mail: romain.gherardi@hmn.ap-hop-paris.fr
Macrophagic myofasciitis (MMF) is an emerging condition of
unknown cause, detected in patients with diffuse arthromyalgias and
fatigue, and characterized by muscle infiltration by granular periodic
acid–Schiff's reagent-positive macrophages and lymphocytes. Intracytoplasmic
inclusions have been observed in macrophages of some patients. To
assess their significance, electron microscopy was performed in 40
consecutive cases and chemical analysis was done by microanalysis
and atomic absorption spectrometry. Inclusions were constantly
detected and corresponded to aluminium hydroxide, an
immunostimulatory compound frequently used as a vaccine adjuvant. A
lymphocytic component was constantly observed in MMF lesions.
Serological tests were compatible with exposure to aluminium
hydroxide-containing vaccines. History analysis revealed that 50 out
of 50 patients had received vaccines against hepatitis B virus
(86%), hepatitis A virus (19%) or tetanus toxoid (58%), 3–96 months
(median 36 months) before biopsy. Diffuse myalgias were more
frequent in patients with than without an MMF lesion at deltoid
muscle biopsy (P < 0.0001). Myalgia onset was subsequent
to the vaccination (median 11 months) in 94% of patients. MMF lesion
was experimentally reproduced in rats. We conclude that the MMF
lesion is secondary to intramuscular injection of aluminium
hydroxide-containing vaccines, shows both long-term persistence of
aluminium hydroxide and an ongoing local immune reaction, and is
detected in patients with systemic symptoms which appeared
subsequently to vaccination.
Copyright ©
2001 Oxford University Press.
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