Macrophagic myofasciitis lesions assess long-term persistence of vaccine-derived aluminium hydroxide in muscl

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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.