Macrophagic myofasciitis (MMF), a condition first reported in France in 1998, is defined by the presence of a stereotyped and immunologically active lesion at deltoid muscle biopsy.
It was recently demonstrated that this lesion is an indicator of long-term persistence of the immunologic adjuvant aluminum hydroxide within the cytoplasm of macrophages at the site of previous intramuscular (IM) injection.
MMF is typically detected in patients with diffuse arthromyalgias that have appeared subsequent to aluminum hydroxide administration…
Patients also report unexplained chronic fatigue. These manifestations are reminiscent of the so-called chronic fatigue syndrome (CFS), a poorly understood condition manifesting as disabling fatigue, musculoskeletal pain, sleep disturbance, impaired concentration, and headaches.
The present study was conducted to determine the proportion of MMF patients fulfilling international criteria for CFS.
Thirty unselected consecutive patients with biopsy-proven MMF identified… regardless of symptoms that led to indication of muscle biopsy.
Chronic fatigue was found in 28 of 30 patients (93%) and was considered disabling in 26 of 30 patients (87%). Sixteen patients (53%) fulfilled CFS criteria…
A history of vaccination was available for 19 of 20 patients. All 19 patients had received IM administration of aluminum-containing vaccine prior to the onset of CFS symptoms, and the delay from the last vaccination to the first manifestations ranged from 1 month to 72 months [6 years]…
MMF should be alternatively considered as a cause of CFS or as an additional exclusion criterion, along with rheumatoid arthritis, lupus, and other diseases, for the diagnosis of idiopathic CFS.
Consequently, we suggest that patients with CFS should be carefully checked for a history of IM administration of aluminum hydroxide, and, if there is consistent chronology, a muscle biopsy to search for MMF at the site of injection should be considered, even many years after onset of symptoms.
Pathophysiology of CFS is still fiercely debated by psychologists, neuroendocrinologists, and immunologists.
Chronic immune stimulation that fails to switch off has been previously reported as a possible cause of CFS, and such a situation may very well result from persistence of the immunologic adjuvant aluminum hydroxide within antigen-presenting cells.