COVID-19 and Dermal Fillers: Should We Really Be Concerned? / COVID y rellenos faciales ¿realmente debemos preocuparnos?

SARS-CoV-2 has caused millions of infections and deaths worldwide and case numbers continue to rise. Besides the effect of the virus on key organs - leading to respiratory illness, anosmia, diarrhea, and fever and other complications - delayed inflammatory reactions to hyaluronic acid dermal fillers, mainly in the face, have also been reported to occur after confirmed SARS-CoV-2 infections and in vaccinated individuals. While delayed inflammatory reactions tend to be self-limiting, they should be diagnosed and treated with corticosteroids, hyaluronidase, and/or antibiotics when necessary. The inflammation is generally not severe, yet these complications are classified as serious adverse events by the US Food and Drug Administration. They appear to be delayed type IV hypersensitivity reactions triggered by the immune system in the presence of SARS-CoV-2 or other viruses, such as those causing influenza, although the underlying mechanisms have not been fully elucidated. Because the longevity of dermal fillers is increasing, while the pandemic continues to evolve and new vaccines are under development, the long-term effects on hyaluronic acid fillers and other bioimplant materials should be studied. Physicians must also be encouraged to report these reactions, however mild, to ensure accurate records.

Immune Checkpoint Inhibitor Induced Pericarditis and Encephalitis in a Patient Treated With Ipilimumab and Nivolumab for Metastatic Melanoma: A Case Report and Review of the Literature.

Immune checkpoint inhibitors (ICIs) have dramatically improved outcomes in melanoma. Common ICI toxicities have become familiar to clinicians; however, rare delayed toxicities remain challenging given the paucity of data with such presentations. We present the unique case of a 61-year-old with metastatic melanoma with two rare, delayed ICI-induced toxicities. After resection of a large symptomatic parietal metastases, this patient received two doses of combination ipilimumab and nivolumab. Five weeks following his second dose, he developed ICI-induced pericarditis with associated pericardial effusion and early signs of tamponade. Corticosteroids were not administered due to a concurrent cerebral abscess. Administration of colchicine, ibuprofen, judicious monitoring, and cessation of immunotherapy led to the complete resolution of the effusion over several weeks. Seven months following his last dose of immunotherapy, the patient developed ICI-associated grade four autoimmune encephalitis, presenting as status epilepticus. High-dose steroid initiation led to rapid clinical improvement. The patient remains in near-complete response on imaging with no recurrence of pericardial effusion and partial resolution of neurological symptoms. ICI-induced pericardial disease and encephalitis carry substantial mortality rates and prompt diagnosis and management is critical. Clinicians must therefore remain vigilant for these rare toxicities regardless of duration of drug exposure or time since cessation of therapy.

COVID y rellenos faciales ¿realmente debemos preocuparnos? / COVID-19 and Dermal Fillers: Should We Really Be Concerned?

La pandemia por COVID ha causado hoy en día millones de afectados, continuando su aumento a nivel mundial. Junto con la afectación los órganos diana clave (aparato respiratorio, anosmia, diarrea, fiebre, etc.), se han descrito reacciones inmunológicas tardías en los rellenos dérmicos por ácido hialurónico (AH), fundamentalmente a nivel facial. Estas alteraciones aparecen tanto en pacientes positivos para el virus, independientemente de la sintomatología sistémica, como en pacientes que han recibido vacunación frente al SARS-CoV-2. Aunque las reacciones suelen ser autolimitadas y autoresolutivas, es importante saber diagnosticarlas y en ocasiones establecer tratamiento con corticoides, hialuronidasa y/o antibióticos. Aunque no son graves, la Administración de Alimentos y Medicamentos de los Estados Unidos (FDA) las ha clasificado como evento adverso serio. Los mecanismos que originan están reacciones no están completamente dilucidados. Parece que son reacciones de hipersensibilidad retardada tipo IV, favorecidas por estímulos inmunológicos que se activan en presencia de la COVID o de otros virus como la gripe. Sin embargo, dado que los rellenos presentan cada vez mayor durabilidad y a que la pandemia continúa su curso, existiendo nuevas vacunas en desarrollo, es esencial la realización de estudios que describan la evolución a largo plazo tanto de los rellenos de AH, como de otros bioimplantes. Así mismo, es esencial alentar a los médicos de que reporten este tipo de reacciones, aunque no revistan gravedad con el objetivo de poder realizar un registro fidedigno de ellas (AU)

SARS-CoV-2 has caused millions of infections and deaths worldwide and case numbers continue to rise. Besides the effect of the virus on key organs — leading to respiratory illness, anosmia, diarrhea, and fever and other complications — delayed inflammatory reactions to hyaluronic acid dermal fillers, mainly in the face, have also been reported to occur after confirmed SARS-CoV-2 infections and in vaccinated individuals. While delayed inflammatory reactions tend to be self-limiting, they should be diagnosed and treated with corticosteroids, hyaluronidase, and/or antibiotics when necessary. The inflammation is generally not severe, yet these complications are classified as serious adverse events by the US Food and Drug Administration. They appear to be delayed type IV hypersensitivity reactions triggered by the immune system in the presence of SARS-CoV-2 or other viruses, such as those causing influenza, although the underlying mechanisms have not been fully elucidated. Because the longevity of dermal fillers is increasing, while the pandemic continues to evolve and new vaccines are under development, the long-term effects on hyaluronic acid fillers and other bioimplant materials should be studied. Physicians must also be encouraged to report these reactions, however mild, to ensure accurate records (AU)

[Translated article] COVID-19 and Dermal Fillers: Should We Really Be Concerned? / COVID y rellenos faciales ¿realmente debemos preocuparnos?

SARS-CoV-2 has caused millions of infections and deaths worldwide and case numbers continue to rise. Besides the effect of the virus on key organs – leading to respiratory illness, anosmia, diarrhea, and fever and other complications – delayed inflammatory reactions to hyaluronic acid dermal fillers, mainly in the face, have also been reported to occur after confirmed SARS-CoV-2 infections and in vaccinated individuals. While delayed inflammatory reactions tend to be self-limiting, they should be diagnosed and treated with corticosteroids, hyaluronidase, and/or antibiotics when necessary. The inflammation is generally not severe, yet these complications are classified as serious adverse events by the US Food and Drug Administration. They appear to be delayed type IV hypersensitivity reactions triggered by the immune system in the presence of SARS-CoV-2 or other viruses, such as those causing influenza, although the underlying mechanisms have not been fully elucidated. Because the longevity of dermal fillers is increasing, while the pandemic continues to evolve and new vaccines are under development, the long-term effects on hyaluronic acid fillers and other bioimplant materials should be studied. Physicians must also be encouraged to report these reactions, however mild, to ensure accurate records (AU)

La pandemia por COVID ha causado hoy en día millones de afectados, continuando su aumento a nivel mundial. Junto con la afectación los órganos diana clave (aparato respiratorio, anosmia, diarrea, fiebre, etc.), se han descrito reacciones inmunológicas tardías en los rellenos dérmicos por ácido hialurónico (AH), fundamentalmente a nivel facial. Estas alteraciones aparecen tanto en pacientes positivos para el virus, independientemente de la sintomatología sistémica, como en pacientes que han recibido vacunación frente al SARS-CoV-2. Aunque las reacciones suelen ser autolimitadas y autoresolutivas, es importante saber diagnosticarlas y en ocasiones establecer tratamiento con corticoides, hialuronidasa y/o antibióticos. Aunque no son graves, la Administración de Alimentos y Medicamentos (FDA) de los Estados Unidos las ha clasificado como evento adverso serio. Los mecanismos que originan estas reacciones no están completamente dilucidados. Parece que son reacciones de hipersensibilidad retardada tipo IV, favorecidas por estímulos inmunológicos que se activan en presencia de la COVID o de otros virus como la gripe. Sin embargo, dado que los rellenos presentan cada vez mayor durabilidad y a que la pandemia continúa su curso, existiendo nuevas vacunas en desarrollo, es esencial la realización de estudios que describan la evolución a largo plazo tanto de los rellenos de AH, como de otros bioimplantes. Así mismo, es esencial alentar a los médicos de que reporten este tipo de reacciones, aunque no revistan gravedad con el objetivo de poder realizar un registro fidedigno de ellas (AU)

Incidence of serum sickness after the administration of Australian snake antivenom (ASP-22).

CONTEXT: Serum sickness is a delayed immune reaction resulting from the injection of foreign protein or serum. Antivenom is known to cause serum sickness but the incidence and characteristics are poorly defined. OBJECTIVE: To investigate the incidence and clinical features of serum sickness following the administration of Australian snake antivenoms. MATERIALS AND METHODS: This was a prospective cohort study of patients recruited to the Australian Snakebite Project who received snake antivenom from November 2012 to March 2014. Demographics, clinical information, laboratory tests and antivenom treatment were recorded prospectively. Patients administered antivenom were followed up at 7-10 days and 6 weeks' post-antivenom. The primary outcome was the proportion with serum sickness, pre-defined as three or more of: fever, erythematous rash/urticaria, myalgia/arthralgia, headache, malaise, nausea/vomiting 5-20 days post-antivenom. RESULTS: During the 16-month period, 138 patients received antivenom. 23 were not followed up (unable to contact, tourist, child, bee sting) and 6 died in hospital. Of 109 patients followed up, the commonest reason for antivenom was venom induced consumption coagulopathy in 77 patients. An acute systemic hypersensitivity reaction occurred post-antivenom in 25 (23%) and 8 (7%) were severe with hypotension. Serum sickness occurred in 32/109 (29%) patients, including 15/37 (41%) given tiger snake, 6/15 (40%) given polyvalent and 4/23 (17%) given brown snake antivenom. There was no association between the volume of antivenom and serum sickness, p = 0.18. The commonest effects were lethargy, headache, muscle/joint aches and fever. DISCUSSION: The incidence of serum sickness after snake antivenom in Australia was higher than earlier investigations which failed to define symptoms or follow-up patients, but similar to more recent studies of antivenoms in the United States. CONCLUSION: Serum sickness is common with Australian snake antivenom but does not appear to be predictable based on the volume of antivenom administered.