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Quttaineh D, Pusztaszeri M, Mlynarek A, Hier MP, Mascarella MA. Latent Granulomatous Foreign Body Reaction to Dermal Fillers: A Case Report. Ear Nose Throat J 2023:1455613231213256. [PMID: 38140878 DOI: 10.1177/01455613231213256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Affiliation(s)
- Danah Quttaineh
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Marc Pusztaszeri
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Michael P Hier
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Marco A Mascarella
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
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Montemurro P, Pellegatta T, Burton H, Pafitanis G. Silicone Migration From Breast Implants: A Case of Ocular Siliconoma and Literature Review. Aesthet Surg J 2023; 43:972-977. [PMID: 36991214 DOI: 10.1093/asj/sjad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Breast augmentation with implants is one of the most popular cosmetic surgery operations performed worldwide. Complications of breast implants are well recognized, and include capsular contracture, implant rupture, and infrequently distant migration of silicone, resulting in siliconoma. Distant migration of silicone can present many years after implantation with a wide variety of signs and symptoms. OBJECTIVES The aim of this study was to describe the authors' experience of orbital silicone migration and to review the literature describing documented cases of distant silicon migration from breast implants, both ocular and nonocular. METHODS In January 2022, a case of breast implant augmentation presented with silicone migration into the right orbit. This rare case was monitored and diagnosed with ocular muscle palsy and diplopia. Here, the authors present the patient's presenting complaint, symptomatology, working investigations, and outcomes. A comprehensive report of all available cases of distant silicone migration is presented along with their associated complications and more specifically ocular silicone migration. RESULTS Systemic migration of silicone from breast implants to the orbital region is extremely rare: a total of 4 previous cases of ocular silicone migration from breast implants have been described previously; the authors describe the fifth case herein. CONCLUSIONS Silicone implant rupture can present with a wide variety of clinical symptoms that may mimic different clinical pathologies. In every patient with a history of breast augmentation with silicone implants, the possibility of silicone migration should be always taken into consideration during the differential diagnosis process. LEVEL OF EVIDENCE: 5
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Neerukonda VK, Lefebvre D, Chatson GP, Stagner AM. Silicone Granulomas of the Eyelids-A Case Series Illustrating a Distant Migratory Phenomenon. Ophthalmic Plast Reconstr Surg 2023; 39:81-87. [PMID: 36136734 DOI: 10.1097/iop.0000000000002255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Exogenous silicone has been reported to migrate to anatomic sights far from an initial injection or implantation site; this phenomenon has been rarely described in the ocular adnexa, especially in the eyelids. We document 3 additional cases of distant migration of silicone implanted elsewhere in the body to the eyelids and review the prior literature on this uncommon event. METHODS A retrospective chart review of 3 patients was conducted along with analysis of diagnostic histopathology. A comprehensive review of the literature regarding dissemination or migration of silicone to the eyelids in patients with either silicone breast implants or silicone facial filler use was performed. RESULTS Cases of silicone migrating to the eyelids from silicone breast implants and silicone-based facial filler are outlined in Tables 1 and 2, respectively. There are 4 total reports of women with silicone breast implants, including the 2 described here, with evidence of migration of silicone to the eyelid. Similarly, 5 cases of silicone-based facial filler with resultant migration of filler to the eyelids were identified, including 2 of the cases presented in this report (1 patient had both silicone breast implants and silicone facial filler). CONCLUSION Silicone is chemically inert, but is known to travel throughout the body, causing a resultant foreign body response in tissue that can adversely affect even the eyelids. Silicone has a relatively characteristic histologic appearance and diagnosis of silicone granuloma highlights the importance of obtaining a thorough clinical history, particularly regarding prior cosmetic injections or breast enhancement surgery. Foreign material/foreign body granuloma is important to consider in patients with deep eyelid nodules of unclear etiology.
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Affiliation(s)
- Vamsee K Neerukonda
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniel Lefebvre
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
- Surgical Service-Ophthalmology, Boston VA Healthcare System, Jamaica Plain, Massachusetts, U.S.A
| | - George P Chatson
- Chestnut Green at The Andovers, North Andover, Massachusetts, U.S.A
- Nashua Plastic Surgery, North II Specialty, Nashua, New Hampshire, U.S.A
| | - Anna M Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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Elahi L, Meuwly M, Meuwly J, Raffoul W, Koch N. Management of Contralateral Breast and Axillary Nodes Silicone Migration after Implant Rupture. Plast Reconstr Surg Glob Open 2022; 10:e4290. [PMID: 35646497 PMCID: PMC9132530 DOI: 10.1097/gox.0000000000004290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/11/2022] [Indexed: 11/26/2022]
Abstract
Background: Silicone implants were developed in 1962 for breast augmentation and became essential in reconstruction after mastectomy. Silicone “bleeding” has been described from both ruptured and intact implants and can induce disseminated granulomatosis due to the component's high fat solubility. If not adequately treated, they can lead to disastrous cosmetic and functional consequences. Because they may mimic malignancy, prompt and reliable diagnosis should be made as early as possible. Methods: We present a clinical case description of multiple intraparenchymal and ipsi/contralateral intraganglionic siliconomas in a woman who had undergone breast reconstruction, and a literature review of the pathophysiology of siliconomas and their diagnosis and management. Results: Silicone migration to the contralateral breast and lymph node is rare and has seldom been described. The mechanism is still debated. Excluding malignancy is a priority, and systematic management must be respected to avoid misdiagnosis or unnecessary investigations. Conclusions: A multidisciplinary approach is essential for siliconoma management. Silicone-related lymphadenopathies do not require follow-up or special treatment unless they interfere with the diagnosis of tumor recurrence. Careful observation is sufficient for asymptomatic siliconomas; however, symptomatic ones should be treated depending on skin involvement and the patient's eligibility for intervention.
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5
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Trinh LN, McGuigan KC, Gupta A. Delayed Granulomas as a Complication Secondary to Lip Augmentation with Dermal Fillers: A Systematic Review. Surg J (N Y) 2022; 8:e69-e79. [PMID: 35252562 PMCID: PMC8894086 DOI: 10.1055/s-0042-1743524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/20/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction
Lip augmentation with dermal filler is rising in popularity. There are generally minimal side effects that are mild and transient. However, long-term complications may occur and include lumps, bumps, nodules, or granulomas. To better understand this uncommon but challenging outcome, we aim to perform a thorough systematic review of the published literature related to nodule or granuloma formation after cosmetic soft tissue augmentation of the lips.
Methods
A search of published literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in April 2021 and included PubMed, ScienceDirect, Embase, Google Scholar, and Cochrane databases. The Medical Subject Headings (MeSH) terms used included the following terms: “lip filler,” “hyaluronic acid,” “lip injection,” “lip augmentation,” “silicone,” “poly-L-lactic acid,” “calcium hydroxyapatite,” “polymethylmethacrylate,” “complications,” “reaction,” “granuloma,” and “nodule.” All studies were reviewed by two independent reviewers. Any discrepancies were resolved by a third reviewer.
Results
The initial search for filler-related nodules or granulomas yielded 2,954 articles and 28 were included in the final analysis containing 66 individual cases of lip nodules. All but one patient was female. The mean age was 50 years. Nodules presented on average 35.2 months or 2.9 years after initial treatment. Thirty-seven nodules underwent histological analysis, the majority of which identified the presence of a foreign-body granuloma. Silicone was the most reported filler used followed by hyaluronic acid. Most cases resolved following multiple treatments including oral antibiotics or steroids followed by surgical excision.
Conclusion
Understanding the sequelae of lip augmentation with filler products allows clinicians to provide safe and effective treatment. Nodules that present months to years following dermal treatment may represent a foreign-body granuloma. A combination of oral antibiotics, intralesional or oral steroids, and surgical excision successfully treated the majority of cases in our study.
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Affiliation(s)
- Lily Nguyen Trinh
- Department of Otolarynology- Head and Neck Surgery, School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Institution, Boston, Massachusetts
| | - Kelly Christine McGuigan
- Department of Otolarynology- Head and Neck Surgery, School of Medicine, Kimmel Medical College, Thomas Jefferson University Sidney, Philadelphia, Pennsylvania
| | - Amar Gupta
- Department of Otolaryngology - Head and Neck Surgery, Facial Plastic Surgery, Los Angeles, California
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Carrasquillo-Bonilla D, Cancel-Artau KJ, Santos-Arroyo A. Delayed-onset granulomatous reaction presenting as chronic facial edema: a review of the diagnostic and therapeutic challenges. J COSMET LASER THER 2022; 23:156-158. [PMID: 35135403 DOI: 10.1080/14764172.2022.2033782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Injection of soft tissue fillers for esthetic purposes is considered a relatively simple, minimally invasive procedure. Although rare, significant complications exist and may occur in the setting of both non-medical grade and medical-grade silicone fillers, administered by untrained or trained providers. We report a case of a 61 y/o male with an unusual case of foreign body granulomas arising on his forehead and periorbital region for the past 3 years. He had no drug allergies or history of trauma. He only recalled administration of "Botox" near the affected area 20 years ago, although he acknowledged being unsure of the nature of the substance. Examination showed bilateral, periorbital, edematous plaques, with subcutaneous nodules on the forehead. Punch biopsy showed multiple vacuoles surrounded by collagen bundles in the dermis, a histiocytic infiltrate, and multinucleated giant cells. Based on clinicopathological correlation, a diagnosis of foreign body granuloma related to silicone filler injections was made. He was treated with intralesional steroids and doxycycline 100 mg twice daily with complete resolution. Physicians should acknowledge this potential complication of silicone fillers and should inquire about their use with close-ended questions. We also review the diagnostic and therapeutic challenges faced by physicians when encountering this diagnosis.
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Affiliation(s)
| | - Karina J Cancel-Artau
- Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Aileen Santos-Arroyo
- Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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Wiggins C, Gupta R, DeBord LC, Ketcham M, Dao H. Multidisciplinary diagnosis of silicone granuloma-associated gluteal inflammation: Combined clinical, radiological and histopathological assessment. Australas J Dermatol 2021; 63:118-120. [PMID: 34463954 DOI: 10.1111/ajd.13706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Claire Wiggins
- Department of Medicine and Pediatrics, University of Texas at Austin Dell Seton Medical Center, Austin, Texas, USA
| | - Rohit Gupta
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Logan C DeBord
- Department of Dermatology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Megan Ketcham
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Harry Dao
- Department of Dermatology, Loma Linda University, Loma Linda, California, USA
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8
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Hallab NJ, Samelko L, Hammond D. Particulate Debris Released From Breast Implant Surfaces Is Highly Dependent on Implant Type. Aesthet Surg J 2021; 41:NP782-NP793. [PMID: 33564817 DOI: 10.1093/asj/sjab051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although breast implants (BIs) have never been safer, factors such as implant debris may influence complications such as chronic inflammation and illness such as ALCL (anaplastic large cell lymphoma). Do different types of BIs produce differential particulate debris? OBJECTIVES The aim of this study was to quantify, investigate, and characterize the size, amount, and material type of both loosely bound and adherent surface particles on 5 different surface types of commercial BIs. METHODS Surface particles from BIs of 5 surface types (n = 5/group), Biocell, Microcell, Siltex, Smooth, SmoothSilk, and Traditional-Smooth, were: (1) removed by a rinsing procedure and (2) removed with ultrapure adhesive carbon tabs. Particles were characterized (ASTM 1877-16) by scanning electron microscopy and energy-dispersive X-ray chemical analysis. RESULTS Particles rinsed from Biocell, Microcell and Siltex were <1 μm in diameter whereas SmoothSilk and Traditional-Smooth surfaces had median sizes >1 μm (range, 0.4-2.7 μm). The total mass of particles rinsed from the surfaces indicated Biocell had >5-fold more particulate compared with all other implants, and >30-fold more than SmoothSilk or Traditional-Smooth implants (>100-fold more for post-rinse adhesion analysis). Energy-dispersive X-ray analysis indicated that the particulate material for Biocell, Microcell, and Siltex was silicone (>50%), whereas particulates from SmoothSilk and Traditional-Smooth implants were predominantly carbon-based polymers, eg, polycarbonate-urethane, consistent with packaging (and were detected on all implant types). Generally, SmoothSilk and Traditional-Smooth implant groups released >10-fold fewer particles than Biocell, Microcell, and Siltex surfaces. Pilot ex vivo tissue analysis supported these findings. CONCLUSIONS Particulate debris released from BIs are highly dependent on the type of implant surface and are a likely key determinant of in vivo performance. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Nadim James Hallab
- Department of Orthopedic Surgery, University of Illinois in Chicago, Chicago, IL, USA
| | - Lauryn Samelko
- Department of Orthopedic Surgery, University of Illinois in Chicago, Chicago, IL, USA
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Bray A, Reyes JVM, Tarlin N, Stern A. Case Series: Hypercalcemia From Granulomatous Silicosis Developing After COVID-19 Infection. J Investig Med High Impact Case Rep 2021; 9:23247096211051206. [PMID: 34654331 PMCID: PMC8521725 DOI: 10.1177/23247096211051206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/16/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022] Open
Abstract
Hypercalcemia is one of the most commonly encountered laboratory abnormalities in clinical medicine. Various causes have been well established. However, it is likely that the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may be a newly found cause of this frequent finding, especially amongst those with a history of cosmetic surgery, specifically by means of silicone injection. In this case series, we describe 2 patients presenting with symptomatic hypercalcemia likely from their prior silicone injections. Interestingly, each patient only developed symptoms of hypercalcemia following infection with SARS-CoV-2.
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Affiliation(s)
- Ashley Bray
- Department of Internal Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Jonathan Vincent M. Reyes
- Department of Internal Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Nancy Tarlin
- Department of Endocrinology, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Aaron Stern
- Department of Nephrology, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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10
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Murakami K, Yamamoto K, Sugiura T, Kirita T. Buccal Silicone Granuloma Caused by the Dental Infection. Case Rep Dent 2020; 2020:8834475. [PMID: 33204544 DOI: 10.1155/2020/8834475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/11/2020] [Accepted: 10/25/2020] [Indexed: 11/21/2022] Open
Abstract
The facial injection of liquid silicone is performed for cosmetic purposes. The use of injectable fillers in facial procedures has become extremely popular over the past decade. Most procedures are performed in the perioral, periocular, and cheek areas of middle-aged women. Even though silicone is biologically inert, its injection can result in the formation of granulomas. Silicone granulomas can result from an inflammatory or autoimmune tissue response. However, the development of silicone granulomas secondary to dental infection has not yet been reported. We report a case of a 73-year-old woman with a right buccal silicone granuloma that developed following a dental infection. Ultimately, this case healed completely after the surgical removal of all lesions. Silicone in the facial region may become infected by a dental infection, and infective silicone develops granulomas and cellulitis. In the context of cosmetic facial silicone injections, it is necessary to improve oral hygiene prior to dental treatment and to maintain a healthy oral environment after surgery. In some cases, surgical treatment using an intraoral approach is effective.
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11
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Killian M, Habougit C, Monard E, Gramont B. Systemic sarcoidosis revealed by venepunctures: a very rare but rewarding cutaneous manifestation. BMJ Case Rep 2020; 13:13/9/e235784. [PMID: 32900730 DOI: 10.1136/bcr-2020-235784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 67-year-old man was referred to our department for the onset of cutaneous lesions following venepunctures. His recent medical history included brief flu-like syndrome, persistent cough, dyspnoea, dry mouth, blurred vision and weight loss. The extensive clinical, biological and radiological check-up showed signs consistent with systemic sarcoidosis: right uveitis, hypercalcemia, renal failure, inflammatory syndrome, elevated levels of ACE, alveolitis with elevated CD4+/CD8+ T cell ratio, hilar and mediastinal lymphadenopathy, bilateral pulmonary infiltrates, mild bronchial obstruction and lowered diffusing capacity of the lungs for carbon monoxide. Multiple biopsy samples (bronchus, accessory salivary glands and one of the skin lesions) eventually confirmed the diagnosis. Corticosteroids resulted in skin lesions resolution in a few days and overall clinical, biological and lung function improvement. The infiltration of scars by granulomatous tissue is well recognised in sarcoidosis but its onset in venepuncture sites is a very rare but easily recognisable condition, which can be helpful for quick diagnosis purpose.
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Affiliation(s)
- Martin Killian
- Department of Internal Medicine, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, Loire, France .,GIMAP, Université Jean Monnet Saint-Etienne, Saint-Etienne, Loire, France
| | - Cyril Habougit
- Laboratory of Pathology, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, Loire, France
| | - Eric Monard
- Department of Internal Medicine, Centre Hospitalier Chalon sur Saone, Chalon-sur-Saone, France
| | - Baptiste Gramont
- Department of Internal Medicine, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, Loire, France
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12
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Pirakitikulr N, Tran AQ, Garcia AL, Dubovy SR, Lee WW. Periorbital Silicone Granulomatosis 30 Years after Acupuncture. Case Rep Ophthalmol Med 2020; 2020:6323646. [PMID: 32670653 DOI: 10.1155/2020/6323646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/05/2020] [Accepted: 05/15/2020] [Indexed: 11/18/2022] Open
Abstract
Silicone-based compounds are commonly used in many medical applications, such as coatings for needles and syringes. Foreign body granulomas are a well-recognized complication of silicone exposure; however, they may be challenging to identify without a clear history. A 61-year-old female patient without prior history of periocular injections, filler, or surgery presented to our oculoplastic clinic with multiple periocular lesions. The patient subsequently underwent excisional biopsy of two prominent lesions, which were identified as granulomas on pathology. Further questioning revealed the cause to be facial acupuncture performed decades prior, and a subsequent targeted exam identified additional lesions at other needling sites. A third lesion was subsequently excised, and there was no recurrence at the last follow-up 3 months postsurgery. Acupuncture is an increasingly common but underrecognized source of silicone exposure and can present up to several decades after exposure as a chronic granulomatous response in a characteristic multifocal pattern.
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Philibert F, Gras-Champel V, Chaby G, Plantier F, Cartier H, Cogrel O, Carmi E. [Eruptive granuloma after injection of Ellansé® successfully treated using methotrexate]. Ann Dermatol Venereol 2020; 147:525-9. [PMID: 32276735 DOI: 10.1016/j.annder.2020.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/21/2019] [Accepted: 02/28/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Collagen stimulators such as Ellansé® are soft tissue fillers able to induce nucleogenesis. We describe a case of eruptive foreign body granulomas following injection of Ellansé® that were successfully treated using methotrexate. CASE REPORT A 47-year-old woman received injections of Ellansé® for the wrinkled aspect of her cheeks. She had previously undergone injections of hyaluronic acid on the nasolabial folds. Nine months after the Ellansé® injections, the patient consulted for the recent appearance of multiple nodules on her face. Histological analysis of one of these nodules confirmed the presence of foreign-body granulomas developed in contact with spherical gaps of a size substantially identical to the Ellansé® vacuoles. Methotrexate 10mg per week for 3 months followed by 20mg per week for 9 months resulted in complete regression of the nodules. DISCUSSION Ellansé® is composed of two biocompatible and bioabsorbable polymers: carboxymethylcellulose, responsible for immediate volume creation, and polycaprolactone, which promotes collagen synthesis. However, any injected product can cause varying degrees of granulomatous reaction. Hyaluronic acid was previously injected at several other sites on the patient's face. These lesions were not the result of poor injection technique. CONCLUSION Although collagen stimulators are biocompatible and bioabsorbable substances, the development of foreign-body granulomas, while rare, is still possible. Methotrexate resulted in significant regression of nodules as of the third month of treatment.
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Broly M, Marie J, Picard C, Demoures A, Raimbault C, Beylot‐Barry M, Cogrel O. Management of granulomatous foreign body reaction to fillers with methotrexate. J Eur Acad Dermatol Venereol 2020; 34:817-820. [DOI: 10.1111/jdv.16027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/01/2019] [Indexed: 11/28/2022]
Affiliation(s)
- M. Broly
- Department of Dermatology Centre Hospitalier Universitaire de Bordeaux Hôpital Saint‐André Bordeaux France
| | - J. Marie
- Department of Dermatology Centre Hospitalier de Périgueux Périgueux France
| | - C. Picard
- Department of Dermatology Centre Hospitalier France‐Etats‐Unis Hôpital de Saint‐Lô Saint‐ Lô France
| | - A. Demoures
- Department of Pathology Centre Hospitalier de Périgueux Périgueux France
| | | | - M. Beylot‐Barry
- Department of Dermatology Centre Hospitalier Universitaire de Bordeaux Hôpital Saint‐André Bordeaux France
| | - O. Cogrel
- Department of Dermatology Centre Hospitalier Universitaire de Bordeaux Hôpital Saint‐André Bordeaux France
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Abstract
Currently, there is a dearth of information regarding the degree of particle shedding from breast implants (BIs) and what are the general biological consequences of BI debris. Thus, it is unclear to what degree BI debris compromises the long-term biological performance of BIs. For orthopedic implants, it is well established that the severity of biological reactivity to implant debris governs long-term clinical performance. Orthopedic implant particulate debris is generally in the range of 0.01 to 100 μm in diameter. Implant debris-induced bioreactivity/inflammation is mostly a peri-implant phenomenon caused by local innate immune cells (eg, macrophages) that produce proinflammatory cytokines such as tumor necrosis factor-α, interleukin-1β, interleukin-6, and prostaglandin 2 (PGE2). In orthopedics, there have been few systemic concerns associated with polymeric implant debris (like silicone) other than documented dissemination to remote organs (eg, liver, spleen, etc.) with no known associated pathogenicity. This is not true of metal implant debris where normal (well-functioning) implants can induce systemic reactions such as delayed type hypersensitivity. Diagnostic analysis of orthopedic tissues has focused on innate (macrophage mediated) and adaptive (lymphocyte-mediated hypersensitivity) immune responses. Orthopedic implant debris-associated lymphocyte cancers have not been reported in over 40 years of orthopedic literature. Adaptive immune responses such as hypersensitivity reactions to orthopedic implant debris have been dominated by certain implant types that produce specific kinds of debris (eg, metal-on-metal total joint prostheses). Orthopedic hypersensitivity responses and atypical BI bioreactivity such as BI-associated anaplastic large cell lymphoma share crossover markers for diagnosis. Differentiating normal innate immune reactivity to particles from anaplastic large cell lymphoma reactions from delayed type hypersensitivity reactions to BI-associated implant debris remains unclear but vital to patients and surgeons.
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Affiliation(s)
- Nadim James Hallab
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Lauryn Samelko
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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