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Fasciitis
Published in Maher Kurdi, Neuromuscular Pathology Made Easy, 2021
Macrophagic myofasciitis is due to the persistence of vaccine-derived aluminum hydroxide at the site of intramuscular injection. It is usually associated with hepatitis A or B and tetanus vaccines. The affected child presents with fever, myalgia, focal skin swelling, and other associated vaccination side effects. Blood work and electrodiagnostic tests usually show non-specific findings. Histologically, the muscle fibers look normal but there is a diffuse infiltration of CD68+ macrophages through the perimysium, without any structural damage to the muscle fibers (Figure 23.1). PAS (+) inclusions containing aluminum deposits may sometimes be seen. Ultrastructurally, aluminum crystalloid materials are seen inside the macrophages.
Rare forms of inflammatory myopathies - part II, localized forms
Published in Expert Review of Clinical Immunology, 2023
Claudio Galluzzo, Ilaria Chiapparoli, Ada Corrado, Francesco Paolo Cantatore, Carlo Salvarani, Nicolò Pipitone
Macrophagic myofasciitis is considered a reaction to hepatitis A, B or tetanus toxoid vaccines containing aluminum. It has mainly been described in middle-aged patients and is clinically characterized by diffuse myalgia and fatigue, although few patients fulfill the 1990 American College of Rheumatology criteria for fibromyalgia. Muscle weakness is rare. Myopathic EMG changes and (mostly modest) CK elevation are found in fewer than half of patients. Histology shows focal infiltration of the epimysium, perimysium and perifascicular endomysium by macrophages with a minor lymphocytic component, mainly consisting of CD8 + T cells forming perivascular cuffs; occasionally B cells (rarely forming lymphoid follicles) and CD138+ plasma cells may be detected. Giant multinucleated cells are absent, and muscle fiber necrosis inconspicuous or lacking. There is no widespread HLA-I expression on muscle fibers nor MAC deposition on capillaries. Aluminum salts are stained by hematoxylin, although not in formalin-fixed material, probably due to artifacts. Macrophagic myofasciitis tends to persist if untreated, but responds to glucocorticoids at doses ranging from 0.3 mg to 1 mg/kg/day of prednisone-equivalent tapering [65].
Clearance, biodistribution, and neuromodulatory effects of aluminum-based adjuvants. Systematic review and meta-analysis: what do we learn from animal studies?
Published in Critical Reviews in Toxicology, 2022
J.-D. Masson, L. Angrand, G. Badran, R. de Miguel, G. Crépeaux
Furthermore, the use of ABAs in human vaccinations has been linked to adverse effects since the late 1990s when Macrophagic Myofasciitis (MMF) was described [MMF, an AH-induced longstanding muscular lesion which is typically clinically associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)] (Gherardi et al. 2001); for review see (Gherardi et al. 2019) and subsequently included as a paradigm of the “Autoimmune (or autoinflammatory) syndrome induced by adjuvants” (ASIA) (Shoenfeld and Agmon-Levin 2011). More recently, increasing concerns have emerged focusing on the role played by early exposure to these Al compounds in cases of neurodevelopmental disorders (Gallagher and Goodman 2010; Tomljenovic and Shaw 2011; Seneff et al. 2012; Shaw and Tomljenovic 2013; Shaw et al. 2013; Mold et al. 2018; Sheth et al. 2018; Wang et al. 2018; Eidi et al. 2020).
HPV vaccines and lupus: current approaches towards preventing adverse immune cross-reactivity
Published in Expert Review of Vaccines, 2019
Nicola L. Bragazzi, Charlie Bridgewood, Kassem Sharif, Mohamad Kamal, Howard Amital, Abdulla Watad, Yehuda Shoenfeld
Apart from molecular mimicry, vaccines result in hyper-stimulation of the immune system. Unlike infectious agents, vaccines frequently contain adjuvants which further enhance immune stimulation [48]. Moreover, aluminum oxyhydroxide (alum), the commonly used vaccine adjuvant in the preparation of HPVv, has been linked to several autoimmune phenomena [49]. Such concerns were based upon the recognition of their integral role in macrophagic myofasciitis (MMF) lesions detected in patients with myalgic encephalomyelitis/chronic fatigue syndrome [49]. These effects seem to occur secondary to the unexpectedly long bio-persistence of alum in immune cells which results in slow brain translocation and increased neurotoxicity [49]. Furthermore, alum is known to strongly stimulate the immune system by inducing a strong antibody (Th2) response, while having low capacity in stimulating a Th1 immune response [48]. In short, the mechanism by which HPVv may lead to an autoimmune phenomenon requires further elucidation, however several lines of evidence may support the role of immune cross-reactivity and immune hyperstimulation as relevant causes of disease induction in genetically susceptible individuals.