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Brain, Vol. 124, No. 5, 974-983, May 2001
© 2001 Oxford University Press

Central nervous system disease in patients with macrophagic myofasciitis

F.-J. Authier1,2,4, P. Cherin4,5, A. Creange1,4, B. Bonnotte8, X. Ferrer9, A. Abdelmoumni10, D. Ranoux7, J. Pelletier11, D. Figarella-Branger12, B. Granel13, T. Maisonobe4,6, M. Coquet4,14, J.-D. Degos3 and R. K. Gherardi1,2,4

1 Groupe d'Études et de Recherches sur le Muscle et le Nerf (GERMEN, EA Université Paris XII–Val de Marne), Faculté de Médecine de Créteil, 2 Département de Pathologie et 3 Service de Neurologie, Hôpital Henri Mondor, AP–HP, Créteil, 4 Groupe d'Études et Recherches sur les Maladies Musculaires Acquises et Dysimmunitaires (GERMMAD) de l'Association Française contre les Myopathies (AFM), 5 Service de Médecine Interne et 6 Laboratoire de Neuropathologie Raymond Escourolle, Groupe Hospitalier Pitié–Salpêtrière, AP–HP, 7 Service de Neurologie, Centre Hospitalier Saint–Anne, Paris, 8 Service de Médecine Interne, Immunologie Clinique et Oncologie, Hôpital du Bocage, Dijon, 9 Service de Neurologie, Hôpital du Haut–Lévêque, Pessac, 10 Service de Neurologie, Hôpital Gilles de Corbeil, Corbeil–Essonne, 11 Service de Neurologie, 12 Service d'Anatomie Pathologique et de Neuropathologie et 13 Service de Médecine Interne, Hôpital d'Adultes de la Timone, Marseille and 14 Service d'Anatomie Pathologique, Hôpital Pellegrin, Bordeaux, France

Correspondence to: François-Jérôme Authier, MD, Département de Pathologie, Hôpital Henri Mondor, AP-HP, 94010 Créteil-cedex, France E-mail: authier@univ-paris12.fr

Macrophagic myofasciitis (MMF), a condition newly recognized in France, is manifested by diffuse myalgias and characterized by highly specific myopathological alterations which have recently been shown to represent an unusually persistent local reaction to intramuscular injections of aluminium-containing vaccines. Among 92 MMF patients recognized so far, eight of them, which included the seven patients reported here, had a symptomatic demyelinating CNS disorder. CNS manifestations included hemisensory or sensorimotor symptoms (four out of seven), bilateral pyramidal signs (six out of seven), cerebellar signs (four out of seven), visual loss (two out of seven), cognitive and behavioural disorders (one out of seven) and bladder dysfunction (one out of seven). Brain T2-weighted MRI showed single (two out of seven) or multiple (four out of seven) supratentorial white matter hyperintense signals and corpus callosum atrophy (one out of seven). Evoked potentials were abnormal in four out of six patients and CSF in four out of seven. According to Poser's criteria for multiple sclerosis, the diagnosis was clinically definite (five out of seven) or clinically probable multiple sclerosis (two out of seven). Six out of seven patients had diffuse myalgias. Deltoid muscle biopsy showed stereotypical accumulations of PAS (periodic acid–Schiff)-positive macrophages, sparse CD8+ T cells and minimal myofibre damage. Aluminium-containing vaccines had been administered 3–78 months (median = 33 months) before muscle biopsy (hepatitis B virus: four out of seven, tetanus toxoid: one out of seven, both hepatitis B virus and tetanus toxoid: two out of seven). The association between MMF and multiple sclerosis-like disorders may give new insights into the controversial issues surrounding vaccinations and demyelinating CNS disorders. Deltoid muscle biopsy searching for myopathological alterations of MMF should be performed in multiple sclerosis patients with diffuse myalgias.


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