Age: 1.3
Sex: F
Vaccine: HEP, VARCEL
Symptoms: Carnitine normal, Dysstasia, Electroneuromyography, Failure to thrive, Gross motor delay
Clinical narrative: This case was reported in a literature article and described the occurrence of macrophagic myofasciitis in a 16.5-month-old female subject who was vaccinated with Varicella vaccine (manufacturer unspecified) and Hepatitis B vaccine. This case corresponds to case 1 in the literature article. The subject's medical history included dehydration and jaundice (at 4 days old) thought to be secondary to maternal ABO blood type incompatibility. She responded well to the treatment. On an unspecified date, the subject received an unspecified dose of Varicella vaccine (administration site and route unknown, batch number not provided) and an unspecified dose of Hepatitis B vaccine (administration site and route unknown, batch number not provided). At an unspecified time after vaccination with Hepatitis B vaccine and Varicella vaccine, the subject experienced macrophagic myofasciitis with gross motor delay and inability to crawl and stand. Her physical examination, at 16.5 months, showed hypotonia with decrease of strength in arm and leg, decreased reflexes and inability to stand without support. She had failure to thrive, her height was at the 50th percentile with a weight at the 10th percentile. This case was assessed as medically serious by GSK. Her CK, serum carnitine, lactate and amino acid profile were normal. The electroneuromyography demonstrated reduced recruitment in the proximal left leg testing but normal in proximal arms and normal sensory and motor nerve conduction studies. It demonstrated evidence of impaired muscle function with lack of voluntary motor unit recruitment in the left quadriceps suggesting the muscle was electrically unexcitable, while the biopsy was performed on the right, suggesting that impaired muscle function was not limited to one muscle or limb. No other organ system involvement was described. No radiological evidence of central nervous system dysfunction or parental consanguinity, and all demonstrated significant improvement in motor function over time. At 17 months, her right vastus lateralis was biopsied. Clinical presentations were characterized by motor delay, hypotonia and failure to thrive with an unrevealing evaluation for central nervous system disease, congenital and mitochondrial myopathies. All muscle biopsy specimens were similar with stereotyped demonstration of epi- peri-, and endomysium macrophagic infiltrates without muscle fiber necrosis. There was no histopathological evidence of ragged red fibers, fiber type atrophy, grouping, or significant impairment of mitochondrial oxidative staining. By the age of 3 years and 9 months, she had improved, demonstrating normal cognition and language development, with ability to run and jump, climb stairs while holding a handrail, and rise from the floor without Gower's maneuver. The author considered that macrophagic myofasciitis was possibly related to vaccination with Varicella vaccine and Hepatitis B vaccine. This case corresponds to 1 of the   [Due to memory limitations, the remainder of this text could not be compared.]  1 of the 3 cases reported in the literature article.