title: Macrophagic myofasciitis in childhood: a controversial entity.
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 periodic-acid-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.
authors.affiliation: Department of Pathology, Neuropathology Section, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Eloy
authors.initials: E
authors.lastname: Rivas
authors.forename: Mercedes
authors.initials: M
authors.lastname: Gómez-Arnáiz
authors.forename: Jose R
authors.initials: JR
authors.lastname: Ricoy
authors.forename: Fernando
authors.initials: F
authors.lastname: Mateos
authors.forename: Rogelio
authors.initials: R
authors.lastname: Simón
authors.forename: Juan J
authors.initials: JJ
authors.lastname: García-Peñas
authors.forename: Maria T
authors.initials: MT
authors.lastname: Garcia-Silva
authors.forename: Elena
authors.initials: E
authors.lastname: Martín
authors.forename: María
authors.initials: M
authors.lastname: Vázquez
authors.forename: Ana
authors.initials: A
authors.lastname: Ferreiro
authors.forename: Ana
authors.initials: A
authors.lastname: Cabello
mesh_terms: D000535:Aluminum / Q000009:adverse effects; D001706:Biopsy; D002675:Child, Preschool; D005208:Fasciitis / Q000276:immunology / Q000473:pathology*; D005260:Female; D006801:Humans; D002479:Inclusion Bodies / Q000473:pathology / Q000648:ultrastructure; D007223:Infant; D008264:Macrophages / Q000473:pathology* / Q000648:ultrastructure; D008297:Male; D008854:Microscopy, Electron; D009220:Myositis / Q000276:immunology / Q000473:pathology*; D052097:Quadriceps Muscle / Q000473:pathology; D014611:Vaccination / Q000009:adverse effects
chemical_list: D000535:Aluminum