Vaccination Safety Update: Macrophagic Myofasciitis

by Prof. Dr. med. habil. Burkhard Schneeweiß, Dr. rer. nat. Michael Pfleiderer, Dr. med. Brigitte Keller-Stanislawski in volume 34–35/2008

We wish to raise awareness of the phenomenon of macrophagic myofasciitis (MMF), which does exist in Germany but has not received much attention. This phenomenon may develop after vaccination. MMF is an acquired inflammatory muscular lesion that manifests focally as round cells located in the perifascicular space while the remaining muscle fibers remain relatively intact. Histopathologically, MMF is characterized by macrophages that are positive for diastase resistant periodic acid-Schiff (PAS) and numerous CD8+ T cells. Tissue necrosis or giant cells are typically not detected. As an expression of lysosomal activity, the macrophages are strongly positive for "acidic phosphatase" and "nonspecific esterase". Electron microscopic studies regularly show numerous needle-shaped structures within the lysosomes of these macrophages. By analyzing a tissue section—so called laser microprobe mass analysis (LAMMA)—the needle-shaped structures can be identified as aluminum hydroxide.

In adults it is almost exclusively the left deltoid muscle (‘vaccination muscle’) that is affected, in children almost exclusively the quadriceps.

Different working groups, mainly in France, postulate a causal association between MMF, aluminium hydroxide containing vaccines—for example, the hepatitis B, hepatitis A, tetanus toxoid vaccines and systemic clinical symptoms. The clinical spectrum, which may occur even up to 10 years after the vaccination, is unspecific and ranges from myalgias and arthralgias to increased fatigue (1, 2).

A comprehensive epidemiological follow-up to establish a possible causal association between focal MMF lesions after vaccination, the use of aluminum hydroxide, and systemic clinical symptoms is required—which, as far as we know, has not been undertaken so far. However—and this is an important message—it is absolutely in no way our intention to question the need for the mentioned vaccinations. DOI: 10.3238/arztebl.2009.0248a

Illustrations on the topic available from the authors.


PD Dr. med. Werner Stenzel
Institut für Neuropathologie
Charité Universitätsmedizin CCM
Charitéplatz 1, 10117 Berlin, Germany
[e-mail]

Prof. Dr. med. Frank L. Heppner
Prof. Dr. med. Hans-Hilmar Goebel
Institut für Neuropathologie
Charité Universitätsmedizin CCM
Charitéplatz 1, 10117 Berlin, Germany

Dr. med. Rieke H. E. Alten
Klinik für Innere Medizin II, Schlosspark-Klinik
Heubnerweg 2, 14059 Berlin, Germany

Conflict of interest statement
The authors declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.

References

1. Gherardi RK et al.: Macrophagic myofasziitis lesions assess long-term persistence of vaccine-derived aluminium hydroxide in muscle. Brain 2001; 124, 1821–31.

2. Papo T: Macrophagic myofasziitis: focal or systemic? Joint Bone Spine 2003; 70: 242–5.

3. Schneeweiß B, Pfleiderer M, Keller-Stanislawski B: Vaccination Safety Update [Impfsicherheit heute]. Dtsch Arztebl Int 2008; 105(34–35): 590–5.