[Macrophagic myofasciitis: inflammatory, vaccination-associated muscular disease].
METHODS
A 67-year-old man presented with a 6-week history of slowly progressive muscle pain and generalized muscular weakness. Neurological examination showed symmetrical proximal weakness (MRC grade 4/5).


METHODS
Laboratory tests revealed an elevated CK level of 124 U/l (normal < 80). Needle EMG showed pathological spontaneous activity in proximal muscle groups. A diagnostic muscle biopsy taken from the left deltoid muscle revealed a characteristic infiltrate of PAS-positive and acid phosphatase-positive macrophages. Electron microscopic analysis of muscle tissue failed to demonstrate aluminium hydroxide inclusion. Serological analysis excluded antibodies against HAV and HBV but was compatible with a previous tetanus vaccination (antibody titre of 2.3 IE/ml).


METHODS
A 2-year treatment with steroids and azathioprine led to complete recovery of muscle strength without relapse after discontinuing the immunosuppression.


CONCLUSIONS
Macrophagic myofasciitis (MMF) is a rare inflammatory muscle disorder characterized by a characteristic infiltration of muscle tissue by PAS-positive macrophages, which is caused by pathological persistence of vaccine-derived aluminium hydroxide. The diagnosis can only be established by an open muscle biopsy from the muscle that was used for intramuscular vaccination.
Neurologische Klinik und Poliklinik, Rheinische Friedrich-Wilhelms-Universität Bonn.
D
D
Fischer
J
J
Reimann
R
R
Schröder
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use; D001706:Biopsy; D004576:Electromyography; D005208:Fasciitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007273:Injections, Intramuscular; D008264:Macrophages; D008297:Male; D009132:Muscles / Q000473:pathology; D009220:Myositis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D013745:Tetanus Toxoid / Q000008:administration & dosage; D013997:Time Factors; D014611:Vaccination / Q000009:adverse effects*
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D013745:Tetanus Toxoid; D001379:Azathioprine