Musher Alice, Diaz Ortiz Melanie S, Diaz Lizarraga Antonio
Department of Medicine, MetroWest Medical Center, Framingham, USA.
Cureus. 2024 Dec 6;16(12):e75220. doi: 10.7759/cureus.75220. eCollection 2024 Dec.
Localized inflammatory reactions in patients with past procedural history of intradermal injections can quickly drive the clinician's attention towards a diagnosis of soft-tissue infection in the context of symptoms such as fever, malaise, and local induration of the adipose panniculus. However, in patients with a long-term history of granulomatous events, a rheumatologic approach must be taken into consideration when the clinical course overwhelms the odds for more conventional diagnoses. In this case, a 39-year-old female patient who underwent bilateral lower limbs intradermal filllers presented with a two-year clinical course of repetitive flares of external bilateral hip tenderness, pain that limits her walking, soft-tissue nodular inflammation, redness, fever and a soft mobile nonpainful right supraclavicular lymphadenopathy. She sought medical attention at the Emergency Department in a community hospital of Framingham, Massachusetts, due to the aggravation of a repeated clinical episode. With a former diagnosis of recurrent bilateral soft-tissue infection, the patient underwent a novel approach different from the suspicion of a resistant pathogen towards the scope of a reminiscent granulomatous condition triggered by the two-year-old cosmetic para gluteal injections. After treatment with a course of systemic steroids and a deeper interrogation of past medical history, her clinical evolution highlighted the importance of seeking appropriate medical counseling prior undergoing cosmetic procedures. This is particularly critical for patients with a history of sarcoidosis, a granulomatous condition that can be flared even decades after the initial diagnosis when it meets specific triggers, such as intradermal injection. This risk is potentially heightened when such procedures are performed by underqualified providers who may lack the skill to gather a comprehensive medical history or, even worse, execute inadequate techniques or work in suboptimal environmental conditions, thereby increasing the potential for harm.
有皮内注射既往史的患者出现局部炎症反应，在伴有发热、不适及皮下脂肪层局部硬结等症状的情况下，会迅速促使临床医生考虑软组织感染的诊断。然而，对于有长期肉芽肿病史的患者，当临床病程排除了更常规诊断的可能性时，必须考虑采用风湿科的诊疗方法。在本病例中，一名39岁女性患者接受了双侧下肢皮内填充治疗，出现了为期两年的临床病程，表现为双侧髋部外侧反复疼痛发作、影响行走的疼痛、软组织结节性炎症、发红、发热以及右侧锁骨上可移动无痛性淋巴结肿大。由于反复临床发作加重，她前往马萨诸塞州弗雷明汉社区医院的急诊科就诊。此前诊断为复发性双侧软组织感染，该患者接受了一种新的诊疗方法，不再怀疑是耐药病原体，而是考虑由两年前臀部旁美容注射引发的类似肉芽肿性疾病。在接受一个疗程的全身类固醇治疗并深入询问既往病史后，她的临床病情发展凸显了在进行美容手术前寻求适当医疗咨询的重要性。这对于有结节病病史的患者尤为关键，结节病是一种肉芽肿性疾病，即使在初次诊断数十年后，遇到特定触发因素（如皮内注射）时仍可能发作。当此类手术由不合格的医疗人员进行时，这种风险可能会增加，他们可能缺乏收集全面病史的技能，甚至更糟的是，技术操作不当或工作环境欠佳，从而增加了伤害的可能性。
