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Giant PMMA Foreign Body Granulomas with Imaging
Sunthosh Sivam1, Christine Mackay2, Clinton Humphrey2
1Baylor College of Medicine, Houston, TX, USA.
Abstract:
Filler complications have a wide array of presentations including early and late manifestations. A rare late complication is the foreign body granuloma or granulomatous foreign body reaction. We present a case of giant foreign body granulomas developing 7 years after polymethylmethacrylate (PMMA) filler injection. The patient had an excellent response to a single intralesional injection of triamcinolone acetonide and 5-fluorouracil. The unique opportunity to have pretreatment and posttreatment magnetic resonance imaging (MRI) allows for appreciation of the multidirectional expansion of these granulomas as well as the response in this case. Updated treatment recommendations based on the literature review support the use of oral antibiotics, oral steroids, and intralesional therapies. Surgical excision is reserved as an absolute last resort due to potential complications.
Insights
Giant foreign body granulomas, a rare complication of polymethylmethacrylate (PMMA) filler, can develop years later. Intralesional injections of triamcinolone acetonide and 5-fluorouracil effectively treated this delayed filler complication.
Area of Science:
- Dermatology
- Plastic Surgery
- Radiology
Background:
- Filler complications encompass diverse presentations, with foreign body granulomas representing a rare late manifestation.
- Polymethylmethacrylate (PMMA) is a dermal filler known for its longevity and potential for delayed adverse reactions.
Observation:
- A case of giant foreign body granulomas emerged 7 years post-PMMA injection.
- Magnetic resonance imaging (MRI) provided unique pre- and post-treatment visualization of granuloma expansion and therapeutic response.
Findings:
- Intralesional triamcinolone acetonide and 5-fluorouracil demonstrated excellent efficacy in resolving the giant foreign body granulomas.
- The treatment resulted in significant reduction of granuloma size and associated inflammatory changes.
Implications:
- This case highlights effective management strategies for rare, late-onset filler complications.
- Non-surgical intralesional therapies are recommended as first-line treatments, reserving surgical excision for refractory cases.
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