ASIA case after injection of liquid silicone

Dysautonomia Following Tetanus, Diphtheria, and Pertussis Vaccine (Tdap): The First Case of Extreme Cachexia Caused by Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA Syndrome) in a Human

Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA; Shoenfeld’s syndrome) comprehends a group of autoimmune conditions that flourish in genetically predisposed individuals, following an external stimulus by the so-called adjuvants. Many adjuvants were described, such as vaccines, aluminum and other metals, silicone, tattoos, among others. Those conditions entail defined diseases, such as sarcoidosis and Sjogren’s syndrome, and generalized complex symptoms, for example, fatigue, sleep disturbance, orthostatic intolerance, and other dysautonomic manifestations. Those complaints were previously associated with autoantibodies against nervous system autonomic receptors, especially antibeta 1 adrenergic receptor antibodies, suggesting the autoimmune component of the condition. Here we report on a case of an 18-year-old woman who presented with extreme cachexia due to severe dysautonomia caused by the ASIA syndrome induced by the tetanus, diphtheria, and pertussis vaccine (Tdap).

Outcomes and Complications of Surgical Removal of Foreign Body Granulomas Due to Illicit Polymer Injection for Cosmetic Purposes

BACKGROUND

Subcutaneous injection of illicit polymers can result in a number of local complications, including injection-site deformity, granulomas, and skin changes.

OBJECTIVES

The aim of this study was to compare postoperative complications and symptom flare in patients undergoing surgical excision of foreign-body granulomas.

METHODS

We retrospectively examined data of patients who underwent surgical removal of foreign-body granulomas caused by polymer injection for cosmetic purposes. The granulomas were removed by ultrasonic-assisted liposuction or en bloc excision with primary closure, skin grafts, or free flaps during 2014 to 2020. Data collected included demographic and operative parameters. Postoperative complications, symptom flare, and time to flare were reported. The relations between type of surgery and complications, symptom flare, and time to flare were determined through statistical analysis.

RESULTS

The final cohort included 49 surgeries (42 primary and 7 secondary) in 35 patients. The overall complication rate was 28.9%, with no significant intergroup differences (30.8%, 20%, 66.7%, and 40%; P = 0.328). Wound dehiscence and skin burns were the main complications. An overall symptom flare of 35.1% in surgically treated areas over a mean period of 28.49 months was reported. Chi-squared test indicated statistical significance between type of surgery and symptom flare (P = 0.004) and between complications and flare (P = 0.013). Kaplan-Meier test for flare was statistically significant (P = 0.006) after comparison of the 4 groups.

CONCLUSIONS

The rate of postoperative complications was similar for each type of surgery. However, en bloc excision and reconstruction by either primary closure or free flap was associated with a significantly decreased rate of symptom flare and a longer symptom-free period.

LEVEL OF EVIDENCE: 4