Delayed hypersensitivity reaction following lip fillers, not one but four times in the same patient.

This case report describes a healthy 25-year-old woman who underwent lip filler augmentation and developed a delayed hypersensitivity reaction not once but four times. A Caucasian female with no medical history presented to the authors in March 2022 with diffuse painful swelling on the left upper lip. Upon examination, the affected area was soft and tender on palpation, with no palpable nodules or lumps. Five days later,the patient reported waking up with tenderness and swelling on her right upper lip this time. Two months after this incident the patient reported that she had experienced two similar incidents at the beginning of May. She again reported waking up with the same symptoms on her right upper lip, which spontaneously resolved within 48 h; and then four days later, she exhibited the same symptoms on her left upper lip. When questioned, she did not recall any flu-like symptoms or signs of COVID-19. She had been vaccinated against COVID-19, but this was long before she had lip fillers injected, namely, in 2020 (two years before the events described here). In this case, no obvious triggering factor was identified, apart from the fact that the patient had been stressed due to upcoming examination. Stress is known to cause flares of autoimmune or infectious diseases, such as herpes simplex virus, through complicated processes that influence immune function. Therefore, stress could have been the triggering factor in the current case.

Distal Humerus Fracture Malunion in Adults: A Case Report and a Review of the Literature.

Introduction: Neglected distal humerus fractures are rare injuries, which the orthopaedic surgeon will not deal many times in his career. We present a case of a young patient with such an injury, who was treated with a corrective osteotomy and fixation, resulting in a very good outcome. This case report highlights the importance of surgical intervention for distal humerus fracture malunion. A narrative review of the literature regarding this topic is presented as well. Case Report. A 42-year-old female patient presented to our department nine weeks after a displaced distal humerus fracture, which was treated conservatively in another institution. Ulnar nerve neuropathy, pain, and severe stiffness of the elbow were her main symptoms. Open correction of the deformity, anatomical reduction of the articular surface, and realignment of the metaphyseal level of the fracture were performed. Six months postoperation, a painless flexion-extension arc of 110° and a normal rotation of the forearm was achieved. Conclusion: Distal humerus fracture malunion is a challenge. The operation needed for this purpose is much more demanding, and postsurgical complications are more likely to occur as opposed to the treatment of acute fractures. If a proper surgery is performed though, a good clinical outcome can be expected.