Macrophagic myofasciitis (MMF) is an inflammatory myopathy, recently described. Clinical symptoms include myalgias, arthralgias, muscle weakness, asthenia, and fever.
Aluminic vaccine adjuvants… have been recently suggested as possible etiopathogenic agents of MMF.
We report 2 cases of MMF observed after hepatitis B vaccination in twin sisters.
Two 64-year-old identical twin sisters were referred to our department for possible rheumatoid arthritis. They had no family history of inflammatory disease.
The first sister’s medical history was unremarkable until December 1993, 6 months after she received a third and final injection of hepatitis B vaccine (Engerix B vaccination, containing aluminic hydroxide, vaccination in April, May, and July, 1993)… At this time, she began complaining of arthritis.
Upper right limb muscle magnetic resonance imaging (MRI) showed general muscle atrophy.
The twin sister had a similar clinical presentation…
Her medical history was unremarkable except for mild asthma and high blood pressure. On admission, she reported peripheral arthritis with myalgias. Neurologic examination showed distal paresthesias and cramps of the 4 limbs, severe weakness of the hand muscles…
The symptoms had started 7 months after intramuscular hepatitis B vaccination in the left deltoid (Engerix B containing aluminic hydroxide)…
[M]uscle biopsy of the left deltoid muscle confirmed the diagnosis of MMF.
We report cases of MMF affecting twin sisters, which occurred 6 –7 months after hepatitis B vaccination. In both cases, clinical symptoms were remarkable because of the importance of arthritis associated with muscle involvement.
Remarkably, although both twin sisters had had complete hepatitis B vaccination, only the second had developed antibodies to the hepatitis B surface antigen. Indeed, the HLA–DRB1*07 allele [genotype], which both twins expressed, is associated with poor humoral responses to hepatitis B vaccination.
[A]dditional factors, perhaps genetic, may influence the occurrence of MMF. Aluminum hydroxyde may trigger unusual muscle inflammatory infiltrates in patients with increased susceptibility…