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Rauso R, Nicoletti GF, Zerbinati N, Lo Giudice G, Fragola R, Tartaro G. Complications Following Self-Administration of Hyaluronic Acid Fillers: Literature Review. Clin Cosmet Investig Dermatol 2020; 13:767-771. [PMID: 33116740 PMCID: PMC7569170 DOI: 10.2147/ccid.s276959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022]
Abstract
The purpose of the present study is to review published literature regarding complications following self-administration of hyaluronic acid (HA) filler. The following keywords were searched in Pubmed and Cochrane database: filler AND self injection, hyaluronic acid AND self injection; filler AND self administration; hyaluronic acid AND self administration. Two authors performed title and abstract eligibility assessment independently. Gray literature and all articles cited in the included papers were also screened and their reference lists were examined to identify other potentially pertinent studies. Non-English papers were excluded. A total of 4 complications following self injection of HA were identified. Conversely, after performing a general search through the Google Internet search engine, with the item “self-injection of hyaluronic acid filler”, there were 604,000 hits. The number of articles reporting complications after the self administration of HA is few. Despite that internet searches on the same topic shows that self-administration of HA fillers is a widely discussed phenomenon in several on-line forums. The present review suggests that complications after self-injection of HA are an under-reported phenomenon.
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Affiliation(s)
- Raffaele Rauso
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialists, University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
| | - Giovanni Francesco Nicoletti
- Plastic Surgery Unit, Multidisciplinary Department of Medicine, Surgery and Odontological Sciences, "Luigi Vanvitelli" University Hospital, Naples, Italy
| | - Nicola Zerbinati
- Dermatology, Department of Medicine and Surgery, "Insubria" University Hospital, Varese, Italy
| | - Giorgio Lo Giudice
- Maxillo-Facial Surgery, Department of Neurosciences, Reproductive and Odontological Sciences, "Federico II" University Hospital, Naples, Italy
| | - Romolo Fragola
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialists, University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
| | - Gianpaolo Tartaro
- Maxillo-Facial Surgery Unit, Multidisciplinary Department of Medicine, Surgery and Odontological Sciences, "Luigi Vanvitelli" University Hospital, Naples, Italy
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Abstract
Lung injury can occur secondary to a myriad of causes, including infection, immunologic disorders, drug toxicity, or inhalational injury among others. Although the list of causative agents is long, the lung’s response to injury is limited resulting in similar patterns of disease irrespective of the cause. From a pathological perspective, acute lung injury refers to a group of entities that present with acute or subacute disease. These conditions are characterized by particular histological patterns including diffuse alveolar damage, acute fibrinous and organizing pneumonia, organizing pneumonia, and eosinophilic pneumonia and clinically correspond to the varying degrees of acute respiratory distress syndrome (Patel et al, Chest 125:197–202, 2004; Beasley et al, Arch Pathol Lab Med 126:1064–1070, 2002; Avecillas et al, Clin Chest Med 27:549–557, 2006; Cottin, Cordier, Semin Respir Crit Care Med 33:462–475, 2012; Ferguson et al, Intensive Care Med 38:1573–1582, 2012). In most cases, the underlying cause will not be apparent from the histological findings requiring close correlation with clinical history and laboratory findings to determine the etiology. Nevertheless, careful search for infectious organisms with application of histochemical and immunohistochemical stains should be performed in all cases in order to identify cases that benefit from more targeted treatment.
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Affiliation(s)
- Annikka Weissferdt
- Associate Professor, Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX USA
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Pasgaard T, Huynh ANT, Gjedsted J. Extracorporeal membrane oxygenation after intravenous injection of paraffin oil. Perfusion 2016; 31:706-708. [PMID: 27178991 DOI: 10.1177/0267659116646180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a rare cause of acute respiratory distress syndrome (ARDS) due to an accidental intravascular injection of paraffin oil. While there is no specific therapy, we decided to support the patient with veno-venous extracorporeal membrane oxygenation (V-V ECMO) to allow the ARDS to resolve. A previously healthy 30-year-old man was admitted to the Emergency Department with acute onset respiratory distress following an injection with paraffin oil for cosmetic purposes. In 36 hours, the patient developed severe ARDS and respiratory support with V-V ECMO was initiated. The patient was successfully weaned from ECMO on day 11 and was discharged from hospital in full recovery.
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Affiliation(s)
- Thomas Pasgaard
- 1 Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Anh-Nhi Thi Huynh
- 2 Department of Emergency Medicine, Herning Hospital, Herning, Denmark
| | - Jakob Gjedsted
- 1 Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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Sarıca Ö, Kayhan A, Demirkürek HC, İğdem AA. Subcutaneous Oleomas Following Sunflower Oil Injection: A Novel Case and Review of Literature. THE JOURNAL OF BREAST HEALTH 2016; 12:141-144. [PMID: 28331751 DOI: 10.5152/tjbh.2016.3115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/18/2016] [Indexed: 11/22/2022]
Abstract
Liquid foreign material injection has been used as an early medical intervention since the end of nineteenth century for the augmentation of body shape. Nowadays, these types of procedures have been abandoned by health professionals due to late onset of serious complications. However, it is still misused by some subcultures such as bodybuilders, passive homosexuals, transsexuals, and patients with mental illness. This article discusses a male patient who injected himself with a large amount of sunflower oil, which became complicated by an inflammatory response-abscess formation and sclerosing lipogranuloma of breasts. The radiologic and pathologic signs of this entity are discussed with a review of the relevant literature. Lack of suspicion of this entity may cause a great delay in establishment of definitive diagnosis, giving rise to prominent morbidity and mortality. It is necessary to know the diagnosis and treatment of this phenomenon because illegal substances that cause factitial panniculitis are widely available on websites and threaten thousands of people, which is anecdotally referred in medical literature. Chronic or recurrent lesions of a bizarre or atypical morphology should alert the physician to this artificial phenomenon. Radiologic findings are most important criteria for diagnosis because self-injection is denied by the patient.
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Affiliation(s)
- Özgür Sarıca
- Clinic of Radiology, Taksim Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkey
| | - Arda Kayhan
- Clinic of Radiology, Esenyurt University Health Services Vocational School, İstanbul, Turkey
| | | | - Ayşenur Akyıldız İğdem
- Clinic of Pathology, Taksim Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkey
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Abstract
The use of intramuscular injection of foreign substances for aesthetic purposes is well known. Complications are usually local to the site of injection but can be potentially lethal. Here, we present a case of "site enhancement oil" use in a 42-year-old man who died from asphyxia due to hanging. Macroscopic and microscopic changes as well as computed tomographic changes in injected musculature are described and the potentially lethal adverse effects after site enhancement oil use are warranted.
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Abstract
The use of steroid compounds formulated in oil for depot injection can be associated with acute pulmonary reactions characterized primarily by cough, but sometimes with other associated symptoms. The pathophysiology of these reactions remains unclear, although they are reported in the literature as 'POMEs' or pulmonary oil micro-embolism events. We report on a large case series and propose a case definition for these events. These events can raise significant concern even though they are often self-limited. It is hoped that clinicians will recognize these events more readily and be able to inform patients better, and that future reports and assessments can benefit from our proposed case definition.
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Abstract
Doping is considered to be a major sports problem. This article describes a new threat and challenge to the sport of bodybuilding; the nonmedical use of a chemical in order to mimic muscle hypertrophy. Although muscle fillers are not new, being used for cosmetic purposes in medicine for a long time, the illegal use of muscle fillers has been increasing during the last few years and decades. The history of cosmetic doping, with particular attention to the Brazilian case, is discussed. Limitations are noted and future needed research is suggested.
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Acute respiratory distress following intravenous injection of an oil-steroid solution. Can Respir J 2011; 18:e59-61. [PMID: 22059184 DOI: 10.1155/2011/743151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A case of acute respiratory distress and hypoxemia following accidental intravenous injection of an oil-steroid solution in a body builder is presented. Chest roentography at the time of presentation showed diffuse bilateral opacities, and computed tomography revealed predominantly peripheral ground-glass opacifications. The patient's symptoms gradually improved over 48 h and imaging of the chest was unremarkable one week later. The pathophysiology, diagnosis and treatment of this rare but potentially lifethreatening complication of intravenous oil injection are discussed.
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Figueiredo VC, Silva PRPD, Trindade RDS, Rose EHD. Doping cosmético: a problemática das aplicações intramusculares de óleos. REV BRAS MED ESPORTE 2011. [DOI: 10.1590/s1517-86922011000100011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O doping no mundo esportivo e na subcultura de atletas profissionais e recreacionais de culturismo já é muito conhecido e estudado pela comunidade acadêmica e científica. Porém, uma nova problemática, que definimos como doping cosmético, inseriu-se há algumas décadas no mundo todo, e tem crescido em importância no Brasil nos últimos anos. Trata-se de injeções sistemáticas de substâncias oleosas por via intramuscular, conhecidas como ADE (vitaminas lipossolúveis A, D e E), com intuito de aumentar volumetricamente o músculo per se, podendo levar a necroses, deformidades físicas ou até mesmo ao óbito. Apresentamos a história do uso cosmético dos preenchedores corporais e revisamos os possíveis efeitos deletérios e fatais que podem resultar do seu abuso, assim como os mecanismos envolvidos na evolução clínica da aplicação destas substâncias. Além disto, apresentamos métodos simples para observação potencial do uso. Pretendemos com este trabalho convocar a classe dos profissionais de saúde para que esta publique relatos de casos quando estes usuários forem atendidos devidos às complicações de tal uso, visto que os casos que até hoje apareceram são apenas o início de uma nova problemática de saúde pública que tende a aumentar consideravelmente.
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Ono S, Hyakusoku H. Complications after self-injection of hyaluronic acid and phosphatidylcholine for aesthetic purposes. Aesthet Surg J 2010; 30:442-5. [PMID: 20601573 DOI: 10.1177/1090820x10374088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Various types of dermal fillers have been developed for soft tissue augmentation, including hyaluronic acid products, which have been approved by regulatory agencies in Europe, the United States, and elsewhere. Phosphatidylcholine (PPC) injection has attracted attention for its application in the treatment of cellulite, weight loss, and skin rejuvenation. Because the public can now buy PPC and similar products from various online pharmacy websites without the involvement of a clinician, there is potential for misuse. The authors discuss two cases of complications experienced by patients after self-injection of hyaluronic acid and PPC for aesthetic purposes.
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Affiliation(s)
- Shimpei Ono
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan.
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Abstract
We report a case of multisystem organ failure after large volume subcutaneous injection of castor oil for cosmetic enhancement. An unlicensed practitioner injected 500 mL of castor oil bilaterally to the hips and buttocks of a 28-year-old male to female transsexual. Immediate local pain and erythema were followed by abdominal and chest pain, emesis, headache, hematuria, jaundice, and tinnitus. She presented to an emergency department 12 hours postinjection. Persistently hemolyzed blood samples complicated preliminary laboratory analysis. She rapidly deteriorated despite treatment and developed fever, tachycardia, hemolysis, thrombocytopenia, hepatitis, respiratory distress, and anuric renal failure. An infectious diseases evaluation was negative. After intensive supportive care, including mechanical ventilation and hemodialysis, she was discharged 11 days later, requiring dialysis for an additional 1.5 months. Castor oil absorption was inferred from recovery of the Ricinus communis biomarker, ricinine, in the patient's urine (41 ng/mL). Clinicians should anticipate multiple complications after unapproved methods of cosmetic enhancement.
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Simmons A, Rouf E, Whittle J. Not your typical pneumonia: a case of exogenous lipoid pneumonia. J Gen Intern Med 2007; 22:1613-6. [PMID: 17846847 PMCID: PMC2219803 DOI: 10.1007/s11606-007-0280-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 04/16/2007] [Accepted: 06/21/2007] [Indexed: 11/24/2022]
Abstract
The constellation of chronic cough, dyspnea, and hemoptysis can include a broad range of differential diagnoses. Although uncommon, exogenous lipoid pneumonia (ELP) should be considered when patients present with this symptom complex. We report a case of a 72-year-old female who presented with hemoptysis, cough, and dyspnea. The admission computed tomography scan of the chest revealed progressive interstitial infiltrates. Bronchoscopy revealed diffuse erythema without bleeding. Culture and cytology of lavage fluid were negative. Open-lung biopsy revealed numerous lipid-laden macrophages and multinucleated foreign-body giant cells. On further questioning, the patient admitted to the daily use of mineral oil for constipation. The diagnosis of ELP was made. The literature review revealed that many cases typically present with chronic cough with or without dyspnea. Our case illustrates an unusual presenting symptom of hemoptysis and the need to identify patients who can be at risk of developing this rare condition.
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Affiliation(s)
- Ashley Simmons
- Division of General and Geriatric Medicine, University of Kansas Medical Center, Mail stop 1020, Wescoe 5026, 3901 Rainbow Boulevard, Kansas, KS 66160, USA.
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Pneumonia lipóide exógena – Caso clínico. REVISTA PORTUGUESA DE PNEUMOLOGIA 2005. [DOI: 10.1016/s0873-2159(15)30527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
UNLABELLED We describe a case of acute lung injury following IV injection of peppermint oil. An 18-yr-old woman injected the oil and developed fulminant pulmonary edema requiring ventilator support. Within 4 h after injection her arterial oxygen tension was 8.1 kPa (60 mm Hg) at an inspired oxygen fraction (F(IO2)) of 0.7 (P/F ratio: 85) despite a positive end expiratory pressure (PEEP) of 20 mbar, therefore meeting criteria for acute respiratory distress syndrome (ARDS). Mean pulmonary artery pressures and pulmonary artery wedge pressures were within normal limits throughout the case (<25 mm Hg and <10 mm Hg, respectively). Ventilation with high PEEP and diuresis resulted in a P/F ratio of 265 after 24 h. The patient was successfully weaned from the ventilator on the 9th day. This report is the first description of the sequelae of IV peppermint oil injection. The injection resulted in pulmonary edema and acute lung injury, presumably due to direct toxicity and a resultant increase in pulmonary vascular permeability. IMPLICATIONS This report is the first description of IV peppermint oil injection. The patient rapidly developed severe fluid overload of the lung and subsequent lung injury that required intubation, mechanical ventilation, and intensive care therapy for 13 days. The pulmonary edema was presumably caused by direct toxicity and an increase in pulmonary vascular permeability.
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Affiliation(s)
- Matthias Behrends
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany
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Tümerdem B, Aydin A, Kesim SN. An unusual case of self-injected bovine fat in liquid form to the face for cosmetic reasons. Aesthetic Plast Surg 2004; 28:251-3. [PMID: 15599541 DOI: 10.1007/s00266-004-4009-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 45-year-old woman injected bovine fat in liquid form in to her periorbital area and nasolabial folds near the lip margin and glabellar area to look younger. She was influenced by a TV program about fat augmentation of the aging face and collagen injection to the wrinkles. Major depression had been diagnosed for this woman 5 years previously, after which she used antidepressants and hypnotics irregularly. The prolonged edema of her face subsided within 3 months, along with the erythema, itching, and firmness at the injection sites. No liposuction of the injected material was planned because it had changed to solid form as soon as it was injected. Additionally, it was thought that surgical excision of the fat would not be effective and could harm the facial nerve branches because magnetic resonance imaging showed diffuse enlargement of subcutaneous tissue. Therefore, a conservative approach, such as medical treatment with close follow-up evaluation was preferred. The reported case is presented not only to add an interesting self-injection case to the literature, but also to show that patients with psychological problems may harm themselves by using inappropriate methods for cosmetic reasons under the effect of inaccurate information obtained from TV programs, press, family, and friends.
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Affiliation(s)
- Burçak Tümerdem
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of medicine, Maltepe University, Istanbul, Turkey,
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Cohen MA, Galbut B, Kerdel FA. Exogenous lipoid pneumonia caused by facial application of petrolatum. J Am Acad Dermatol 2003; 49:1128-30. [PMID: 14639399 DOI: 10.1016/s0190-9622(03)00445-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Exogenous lipoid pneumonia is a well-described entity in the literature. To our knowledge, this is the first reported case that occurred secondary to external application of petrolatum to the face for erythrodermic psoriasis.
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Affiliation(s)
- Mark A Cohen
- Department of Dermatology and Cutaneous Surgery, University of Miami, Cedars Medical Center, 1400 NW 12th Avenue, Miami, FL 33136, USA
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Seifert SA, Dart RC, Kaplan EH. Accidental, intravenous infusion of a peanut oil-based medication. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 1998; 36:733-6. [PMID: 9865244 DOI: 10.3109/15563659809162624] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To describe a case of fat embolus syndrome with lipoid pneumonia resulting from intravenous infusion of lipid and to illustrate the potential for accidental intravenous administration of vegetable oil-based progesterone preparations in the treatment of oncology patients. CASE REPORT A patient with recurrent ovarian carcinoma accidentally received approximately 20 mL (0.29 mL/kg) of a peanut oil-based methylprogesterone product intravenously via infusion pump over 24 hours. The patient developed a lipoid pneumonia with dyspnea, cough, hypoxia, radiographic infiltrates, and a pleural effusion. She was hospitalized for 4 days, and signs and symptoms resolved over 2 weeks following steroids and supportive care. DISCUSSION Experience with accidental or intentional intravenous lipid overdose in humans is limited. Typical findings of fat embolus syndrome are similar to lipid aspiration, with respiratory distress, hypoxia, and pulmonary infiltrates. In contrast to aspiration, however, fat embolus syndrome results in lipogranulomas surrounding blood vessels, rather than air passages, and potentially produces cerebrovascular, accident-like symptoms. Management of fat embolus syndrome is similar to that for lipid aspiration. However, as seen in this case, fat embolus syndrome typically resolves over several weeks as opposed to the 3-month to 1-year period seen with aspiration lipoid pneumonias. CONCLUSIONS Accidental intravenous infusion of vegetable oil-based products is a potential complication of the increased use of intravenous progesterones.
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Affiliation(s)
- S A Seifert
- Rocky Mountain Poison and Drug Center, Denver, Colorado 80220-6800, USA.
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