Asunto(s)
Granulomatosis con Poliangitis/diagnóstico , Úlceras Bucales/diagnóstico , Úlcera Cutánea/diagnóstico , Piel/patología , Dorso , Biopsia , Ciclofosfamida/uso terapéutico , Quimioterapia Combinada , Glucocorticoides/uso terapéutico , Granulomatosis con Poliangitis/tratamiento farmacológico , Granulomatosis con Poliangitis/inmunología , Granulomatosis con Poliangitis/patología , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Úlceras Bucales/tratamiento farmacológico , Úlceras Bucales/inmunología , Úlceras Bucales/patología , Valor Predictivo de las Pruebas , Prednisolona/uso terapéutico , Factores de Riesgo , Piel/efectos de los fármacos , Piel/inmunología , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/inmunología , Úlcera Cutánea/patología , Resultado del TratamientoRESUMEN
A new resorbable filler, Matridex, became commercially available during the last years with scarce evidence regarding side effects. A 43-year-old woman complained of multiple, painful, reddish, nonulcerated, hard nodules on both cheeks and periocular regions. Four weeks before, she had been injected by a general practitioner with Matridex for aesthetic purposes to correct wrinkles in the same areas of the nodular eruption. Histopathology showed a diffuse suppurative granulomatous reaction with the presence of multinucleate giant cells and many neutrophils involving the entire dermis. No areas of caseation were observed. The inflammatory granulomatous reaction surrounded 2 different types of nonpolarizing, bluish, exogenous material: one arranged in filamentous structures and the second composed by large spherical particles. All nodules were incised and drained; the patient received systemic antibiotic treatment for 2 consecutive weeks. The nodules progressively regressed and almost complete resolution was seen after 6 months. Matridex is a new resorbable filler constituted by a mixture of nonanimal-stabilized hyaluronic acid (HA), cross-linked HA, and dextranomer microspheres. Foreign body reactions have been described in association with other HA fillers, but a granulomatous reaction after the injection of Matridex has not been reported yet. Interestingly, in our patient, we were able to identify both fragments of HA: the filamentous particles and the spherical particles of dextranomer microspheres within the infiltrate, these last giving a characteristic and recognizable appearance to the histopathological picture.