Macrophagic myofasciitis (MMF)
Diseases
R. K.
Gherardi, M. Coquet, P. Cherin, L. Belec, P. Moretto, P. A. Dreyfus, J.-F. Pellissier,
P. Chariot and F.-J. Authier
Macrophagic myofasciitis lesions assess long-term persistence of vaccine-derived
aluminium hydroxide in muscle http://brain.oupjournals.org/cgi/content/abstract/124/9/1821
(WHALE: a/al2.html)
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.