Late-onset immune-mediated adverse effects after poly-L-lactic acid injection in non-HIV patients: clinical findings and long-term follow-up.
BACKGROUND
It has been thought that poly-L-lactic acid (PLLA) injections do not have inflammatory side effects. Recent evidence shows that local/regional/systemic delayed adverse effects may appear with its use.


OBJECTIVE
To evaluate the clinical complaints, treatment response and long-term follow-up of non-HIV patients with delayed immune-mediated adverse effects related to PLLA injections.


METHODS
Prospective, case series study of 10 patients with delayed adverse effects related to PLLA injections. The inclusion criterion was defined as the onset at least 6 months after PLLA use, with 1 or more of the following clinical signs: oedema, skin induration, swelling/tender nodules with or without discharge of pus or filler material. Several systemic manifestations were also included. Patients with immediate side effects were excluded. Patients underwent clinical management and long-term follow-up.


RESULTS
The average latency period to the onset of symptoms was 19.2 months (range: 6-60). Tender, inflammatory nodules and facial oedema were commonly seen. One case presented a systemic granulomatous disorder as a complication. After 50.2 months of average follow-up (range: 38-78), 5 patients are in remission, 4 have recurrent bouts and the last case has been lost to follow-up.


CONCLUSIONS
Although infrequently, local and/or regional and/or systemic delayed and recurrent granulomatous reactions may complicate PLLA gel injections.
Department of Internal Medicine I, Vall d'Hebron University Hospital, Barcelona, Spain. 16297jar@comb.es
Jaume
J
Alijotas-Reig
Victor
V
Garcia-Gimenez
Miquel
M
Vilardell-Tarres
D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D003357:Cosmetic Techniques; D004487:Edema / Q000139:chemically induced; D005145:Face; D005260:Female; D005500:Follow-Up Studies; D015745:Granuloma, Foreign-Body / Q000209:etiology; D015658:HIV Infections / Q000150:complications; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D007267:Injections; D019344:Lactic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D011091:Polyesters; D011108:Polymers / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D012060:Rejuvenation; D016896:Treatment Outcome
D001672:Biocompatible Materials; D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)