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Abstract
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.