Central nervous system disease in patients with macrophagic myofasciitis

Macrophagic myofasciitis (MMF), a condition newly recognized in France, is manifested by diffuse myalgias and characterized by highly specific myopath ological alterations which have recently been shown to represent an unusual ly persistent local reaction to intramuscular injections of aluminium-conta ining vaccines. Among 92 MMF patients recognized so far, eight of them, whi ch included the seven patients reported here, had a symptomatic demyelinati ng CNS disorder. CNS manifestations included hemisensory or sensorimotor sy mptoms (four out of seven), bilateral pyramidal signs (six out of seven), c erebellar signs (four out of seven), visual loss (two out of seven), cognit ive and behavioural disorders (one out of seven) and bladder dysfunction (o ne out of seven). Brain T-2-weighted MRI showed single (two out of seven) o r multiple (four out of seven) supratentorial white matter hyperintense sig nals 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. Accordi ng to Poser's criteria for multiple sclerosis, the diagnosis was clinically definite (five out of seven) or clinically probable multiple sclerosis (tw o out of seven). Six out of seven patients had diffuse myalgias, Deltoid mu scle biopsy showed stereotypical accumulations of PAS (periodic acid-Schiff )-positive macrophages, sparse CD8+ T cells and minimal myofibre damage. Al uminium-containing vaccines had been administered 3-78 months (median = 33 months) before muscle biopsy (hepatitis B virus: four out of seven, tetanus toroid: one out of seven, both hepatitis B virus and tetanus toroid: two o ut of seven). The association between MMF and multiple sclerosis-like disor ders may give new insights into the controversial issues surrounding vaccin ations and demyelinating CNS disorders. Deltoid muscle biopsy searching for myopathological alterations of MMF should be performed in multiple scleros is patients with diffuse myalgias.