Shaheen Sameh, Al-Habbaa Ahmed, Riad Mohamed Saeid, Mandour Ahmed Saied, Elzeny Mahmoud Ali, Alnady Khaled
Ain-Shams University, Faculty of medicine, Cairo, Egypt.
Armed Forces College of Medicine (AFCM), Cardiology department, Cairo, Egypt.
Egypt Heart J. 2023 Oct 10;75(1):83. doi: 10.1186/s43044-023-00415-9.
Despite the fact that injectable filler usage in the gluteal region has not been recommended in formal medical institutions, illegal procedures are performed in many clinics and beauty centers across Egypt. This case report illustrates the illegal practice culminating in a fatal complication.
A 26-year-old female with no relevant medical history presented to the ER with acute onset shortness of breath. The complaint started 16 h before, with a rapidly progressive course, shortly after undergoing a gluteal filler injection at a center in Cairo. At ER, the patient was severely distressed, yet fully conscious and oriented. She was shocked (BP 70/40 mmHg), tachycardic (130 BPM), and tachypneic (30/min) with normal temperature. She had congested pulsating neck veins with positive Kussmaul sign. Chest auscultation revealed normal vesicular breathing with equal air entry and no adventitious sounds. Her O2 saturation was 60% on room air that improved to 85% on O2 mask. ECG showed sinus tachycardia. Echocardiography showed dilated right side, D-shaped septum with systolic flattening, dilated IVC, mild tricuspid regurgitation and estimated RV systolic pressure 53 mmHg. Her ABG showed compensated metabolic acidosis with elevated lactate level. At the ICU, CVP was 18 mmHg. Saline infusion was continued along with noradrenaline infusion initiation. A provisional diagnosis of high-risk pulmonary embolism was made, though CT pulmonary angiography was not available. Accordingly, thrombolytic therapy was initiated with alteplase (100 mg) over 2 h. Also, a dose of pulse steroids (methylprednisolone 200 mg) was given. Chest X-ray showed bilateral heterogenous opacity and ABG showed deteriorating hypoxia and combined metabolic and respiratory acidosis. The patient was intubated upon deterioration of conscious level and was put on mechanical ventilation. Her ET tube showed frequent blood-tinged secretions. Echocardiography showed more right-side dilatation that was consistent with deterioration of clinical status. Three hours after admission the patient developed cardiac arrest and died 2 h later.
This case report highlights the dangers associated with injectable filler usage in the gluteal region. Physicians and patients should be aware of the possible complications and how to avoid it.
尽管正规医疗机构不建议在臀部区域使用注射填充剂，但埃及各地的许多诊所和美容中心仍在进行非法操作。本病例报告说明了这种非法行为最终导致了致命并发症。
一名26岁无相关病史的女性因急性起病的呼吸急促被送往急诊室。症状于16小时前开始，在开罗的一家中心接受臀部填充剂注射后不久，病情迅速进展。在急诊室，患者极度痛苦，但意识清醒、定向力正常。她休克（血压70/40 mmHg）、心动过速（130次/分）、呼吸急促（30次/分），体温正常。她的颈静脉充血搏动，库斯莫尔征阳性。胸部听诊显示正常的肺泡呼吸音，双侧呼吸音均等，无附加音。在室内空气中她的氧饱和度为60%，吸氧面罩吸氧后升至85%。心电图显示窦性心动过速。超声心动图显示右心室扩大，室间隔呈D形并在收缩期扁平，下腔静脉扩张，轻度三尖瓣反流，估计右心室收缩压为53 mmHg。她的动脉血气分析显示代偿性代谢性酸中毒，乳酸水平升高。在重症监护病房，中心静脉压为18 mmHg。继续输注生理盐水并开始输注去甲肾上腺素。尽管无法进行CT肺动脉造影，但初步诊断为高危肺栓塞。因此，开始用阿替普酶（100 mg）进行2小时的溶栓治疗。此外，还给予了一剂冲击剂量的类固醇（甲泼尼龙200 mg）。胸部X线显示双侧不均匀性模糊影，动脉血气分析显示缺氧恶化，合并代谢性和呼吸性酸中毒。患者在意识水平恶化后插管并接受机械通气。她的气管内导管显示频繁有血性分泌物。超声心动图显示右心室进一步扩大，这与临床状况恶化一致。入院3小时后患者发生心脏骤停，2小时后死亡。
本病例报告强调了在臀部区域使用注射填充剂的危险性。医生和患者应了解可能的并发症以及如何避免。
