Kalil Ricardo K, Monteiro Altamir, Lima Maria Isabel, Silveira Eni B, Foltran Francineide S S, Martins Carlos E Speck, Rizzo Isabela M
Surgical Pathology and Electron Microscopy Laboratories, Sarah Network of Rehabilitation Hospitals, Brasilia, Brazil.
Ultrastruct Pathol. 2007 Jan-Feb;31(1):45-50. doi: 10.1080/01913120601169550.
Macrophagic myofasciitis (MMF) is an inflammatory myopathy related to aluminum-containing vaccines. Described in 1998, most cases were reported in adults, with only 22 cases being reported in children. Three children aged between 13 months and 3(1/2) years were investigated in our institution for neuromuscular symptoms. They underwent thorough clinical, familial, and laboratory investigations, electroneuromyography, muscle biopsy with transmission electron microscopy, scanning electron microscopy/energy dispersive spectroscopy (SEM/EDS), and, in one case, brain magnetic resonance imaging. They had received regular immunizations. Two patients were hypotonic and one presented with myotonia. Muscle biopsy of all patients presented macrophagic infiltrates with intracytoplasmic aluminum content as revealed by SEM/EDS analysis. Their diverse clinical picture does not support a direct relationship between local morphologic findings and systemic symptoms. The atypical clinical presentation of these children may not result from the superposition of MMF upon a background systemic neuromyopathy, suggesting instead that they are two coincident and independent conditions. Although the finding of macrophage infiltrates in muscle tissue is not new, the identification of aluminum content is recent. The use of tissue sections for aluminum detection and mapping by SEM/EDS is conclusive for, diagnosis; it has not been reported previously in a pathology journal, to the authors' knowledge.
巨噬细胞性肌炎（MMF）是一种与含铝疫苗相关的炎性肌病。1998年首次被描述，大多数病例报道于成人，儿童病例仅22例。我院对3名年龄在13个月至3岁半之间出现神经肌肉症状的儿童进行了调查。他们接受了全面的临床、家族史及实验室检查、肌电图检查、肌肉活检（包括透射电子显微镜检查、扫描电子显微镜/能谱分析（SEM/EDS）），其中1例还进行了脑磁共振成像检查。他们均接受过常规免疫接种。2例患儿表现为肌张力减退，1例出现肌强直。所有患者的肌肉活检均显示有巨噬细胞浸润，SEM/EDS分析显示胞浆内含有铝。其多样的临床表现不支持局部形态学表现与全身症状之间存在直接关联。这些儿童的非典型临床表现可能并非MMF叠加于背景性全身性神经肌肉病之上所致，相反，提示二者为两种并存且独立的病症。尽管在肌肉组织中发现巨噬细胞浸润并非新鲜事，但铝含量的鉴定却是最近才出现的。利用组织切片通过SEM/EDS进行铝检测和定位对诊断具有决定性意义；据作者所知，此前尚未在病理学杂志上报道过。
