Pediatric and Developmental Pathology

, Volume 5, Issue 2, pp 151–158

Aluminum Phagocytosis in Quadriceps Muscle following Vaccination in Children: Relationship to Macrophagic Myofasciitis

  • Atilano G. Lacson
  • Cyril A. D’Cruz
  • Enid Gilbert-Barness
  • Leroy Sharer
  • Sergio Jacinto
  • Rosa Cuenca
Article

DOI: 10.1007/s10024001-0137-8

Cite this article as:
Lacson, A.G., D’Cruz, C.A., Gilbert-Barness, E. et al. Pediatr. Dev. Pathol. (2002) 5: 151. doi:10.1007/s10024001-0137-8

Abstract

Macrophagic myofasciitis (MMF) is a rare, seemingly emerging entity among adult patients in France. We encountered two children with the first two cases of MMF in North America. A 5-year-old male with chronic intestinal pseudo-obstruction required nighttime parenteral nutrition. Abnormal pupillary reflexes and urinary retention suggested a diffuse dysautonomia, which prompted a neurological diagnostic work-up. A 3-year-old child had developmental delay and hypotonia. Both children received age-appropriate immunizations. Quadriceps muscle biopsy from each child showed the typical patchy, cohesive centripetal infiltration of α-1-antitrypsin+, α-1-antichymotrypsin+, CD68+, PAS+, CD1a, S-100, factor XIII granular macrophages with adjacent myofiber atrophy, dilated blood vessels, and mild endomysial and perimysial fibrosis. No myonecrosis was observed and no discrete granulomas were seen. A single aluminum peak was demonstrated on energy dispersive X-ray microanalysis. The etiology of the clinical symptoms in these cases and in cases reported as MMF remains intriguing. Despite numerous stains to demonstrate organisms, most infectious causes leading to macrophage activation were ruled out. These cases are being reported to increase awareness of this condition and to encourage a systematic epidemiologic and clinicopathologic study in North America.

Key words: aluminum, children, inflammatory myopathy, myofasciitis, macrophage, phagocytosis, vaccine

Copyright information

© Society for Pediatric Pathology 2002

Authors and Affiliations

  • Atilano G. Lacson
    • 1
  • Cyril A. D’Cruz
    • 2
  • Enid Gilbert-Barness
    • 3
  • Leroy Sharer
    • 4
  • Sergio Jacinto
    • 5
  • Rosa Cuenca
    • 6
  1. 1.Departments of Pediatrics and Pathology, University of South Florida at All Children’s Hospital, 801 Sixth Street South 7020, St. Petersburg, FL 33731, USAUSA
  2. 2.Department of Pathology, Children’s Hospital of New Jersey at Newark, Beth Israel M, 201 Lyons Avenue at Osborn Terrace, Newark, NJ 07112, USAUSA
  3. 3.Departments of Pediatrics and Pathology, University of South Florida at Tampa General Hospital, P.O. Box 1289, Tampa, FL 33601, USAUSA
  4. 4.Department of Pathology and Laboratory Medicine, Division of Neuropathology, New Jersey Medical School, Medical Science Building, C-525, 185 South Orange Avenue, University Heights, Newark, NJ 07103-2714, USAUSA
  5. 5.23098 West Dr. M.L. King, Jr. Boulevard, Suite 3, Tampa, FL 33607, USAUSA
  6. 6.Department of Pediatric Gastroenterology, St. Joseph’s Medical Arts Building, 3003 West Dr. M.L. King, Jr. Boulevard, Tampa, FL 33607, USAUSA