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A6638 - Acute Hypoxic Respiratory Failure and Diffuse Alveolar Hemorrhage Due to Intramuscular Injection of an Oil-Based Cosmetic Substance
Author Block: C. N. Parkhurst1, D. C. Weir1, K. Rajwani1, N. Narula2; 1Pulmonary and Critical Care Medicine, Weill-Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States, 2Pathology and Laboratory Medicine, Weill-Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States.
Synthol is a cosmetic oil-based filler that is injected intramuscularly by bodybuilders in order to generate the appearance of increased muscle mass. Here we report a case of acute lung toxicity related to Synthol injection in a young male bodybuilder.
A 33 year-old male with a history significant for anxiety and depression presented to the emergency department with fatigue, dyspnea, and a dry cough for approximately one week. Additional history at presentation included recent use of nasally inhaled cocaine, unprotected intercourse with multiple male and female partners, and self-injection of Synthol into his pectoral muscles. Initial vital signs were remarkable for a spO2 of 83% on room air and a heart rate of 102. His exam was notable for bibasilar rales and tachypnea but was otherwise unremarkable. Laboratory data revealed a white blood cell count of 12,400 cells/L, hemoglobin of 10.2 g/dL, creatinine of 1.34 mg/dL, and a total bilirubin of 1.5. HIV p24 antigen testing subsequently returned as positive. CT chest without contrast demonstrated diffuse bilateral hazy ground glass airspace opacification as well as edema and skin thickening within bilateral breast tissue. Given concern for Pneumocystis pneumonia, the patient was started on trimethoprim-sulfamethoxazole and prednisone. Bronchoscopy with bronchial alveolar lavage (BAL) and transbronchial biopsy was performed. His endobronchial mucosa was unremarkable, however serial lavage from the right middle love returned increasingly bloody specimens consistent with diffuse alveolar hemorrhage (DAH). BAL fluid was negative for Pneumocystis jirovecii by polymerase chain reaction. Histopathology from transbronchial biopsies of the right upper lobe demonstrated alveolated lung parenchyma with intra-alveolar hemorrhage, reactive type II pneumocyte hyperplasia, mild chronic inflammation, and focal fibrin with organization. Additionally, scattered vacuoles in the interstitium and foamy macrophages in the alveoli were observed. Given these findings antibiotics were discontinued and tapering doses of prednisone were continued with resolution of the patient’s symptoms and hypoxia.
Multiple local and systemic complications of intramuscular oil injection including Synthol have been reported in the literature including skin and muscle infection, fibrosis, necrosis, and vasculitis. Pulmonary complications of Synthol injection have also been reported- specifically acute hypoxic respiratory failure and pneumonitis. Here we report a second case of acute lung injury related to Synthol injection, and add to the general body of knowledge related to this drug-induced lung toxicity with findings of DAH, as well as providing histopathological evidence of lipoid lung injury.