Rivas Eloy, Gómez-Arnáiz Mercedes, Ricoy Jose R, Mateos Fernando, Simón Rogelio, García-Peñas Juan J, Garcia-Silva Maria T, Martín Elena, Vázquez María, Ferreiro Ana, Cabello Ana
Department of Pathology, Neuropathology Section, Hospital Universitario 12 de Octubre, Madrid, Spain.
Pediatr Neurol. 2005 Nov;33(5):350-6. doi: 10.1016/j.pediatrneurol.2005.05.024.
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.
巨噬细胞性肌炎是一种罕见的炎症性肌病，几乎仅在患有弥漫性关节痛和乏力的法国成年人中报道过。其特征是在接种疫苗部位的肌肉活检中，有密集堆积的巨噬细胞浸润，巨噬细胞内含有颗粒状高碘酸-希夫染色阳性物质。这些巨噬细胞中铝包涵体的存在表明对某些疫苗中用作佐剂的铝存在不适当反应。虽然在成年人中这个疾病已得到明确界定，但儿童病例报告少于15例。本研究描述了7名3岁以下儿童，其股四头肌活检有典型的巨噬细胞性肌炎病变。5例进行活检是为了排除线粒体病变。所有儿童均出现肌张力减退以及运动或精神运动发育迟缓，并伴有其他症状。6例神经影像学检查异常。在4例接受检测的病例中，有3例光谱分析研究检测到肌肉中铝含量升高。尽管疫苗在儿童中广泛使用，但巨噬细胞性肌炎在儿童中很少见，其特征性组织学模式与独特的临床综合征并无关联。
