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Dtsch Med Wochenschr. 2003 Oct 31;128(44):2305-8.

[Macrophagic myofasciitis: inflammatory, vaccination-associated muscular disease].

[Article in German]

Author information

1
Neurologische Klinik und Poliklinik, Rheinische Friedrich-Wilhelms-Universität Bonn.

Abstract

HISTORY AND ADMISSION FINDINGS:

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).

INVESTIGATIONS:

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).

TREATMENT:

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

CONCLUSION:

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.

PMID:
14593574
DOI:
10.1055/s-2003-43184
[Indexed for MEDLINE]

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