VACCINE

Pediatrics And Neurology • November 2005
Macrophagic myofasciitis in childhood:
a controversial entity
Author information
Rivas E1, Gómez-Arnáiz M, Ricoy JR, Mateos F,
Simón R, García-Peñas JJ, Garcia-Silva MT, Martín E,
Vázquez M, Ferreiro A, Cabello A.
Department of Pathology, Neuropathology Section
Hospital Universitario 12 de Octubre, Madrid, Spain
Abstract
Macrophagic myofasciitis is an unusual inflammatory myopathy, which has been almost
exclusively reported in French adults with diffuse arthromyalgias and asthenia. It is
characterized by an infiltrate of densely packed macrophages, with granular periodicacid-Schiff
positive content, on muscle biopsies at the site of vaccination. The presence
of aluminum inclusions in these macrophages points to an inappropriate reaction to
aluminum used as an adjuvant in some vaccines. Although in adults this entity is well
defined, less than 15 cases have been reported in children. This study describes seven
children, younger than 3 years of age, with typical lesions of macrophagic myofasciitis
on quadriceps muscle biopsy. In five cases, biopsies were performed to exclude mitochondrial
pathology. All the children developed hypotonia and motor or psychomotor
delay, associated with others symptoms. Abnormal neuroimaging was evident in six
cases. Spectrometry studies detected elevated levels of aluminum in muscle in three of
four cases tested. Despite the wide use of vaccines in childhood, macrophagic myofasciitis
was rarely observed in children and its characteristic histologic pattern could not
be correlated with a distinctive clinical syndrome.
“Although in adults this entity is well defined,
less than 15 cases have been reported in children.
This study describes seven children, younger than 3
years of age, with typical lesions of macrophagic
myofasciitis on quadriceps muscle biopsy.”
http://www.ncbi.nlm.nih.gov/pubmed/?term=16243223