title: Human adjuvant disease induced by foreign substances: a new model of ASIA (Shoenfeld's syndrome).
abstract: OBJECTIVE
  To investigate the clinical, laboratory and histological manifestations of patients who received illegal injections of foreign substances for cosmetic purposes.
  
  
  METHODS
  We studied patients who met the following inclusion criteria: 1) history of application of foreign substances for cosmetic purposes, 2) clinical data of autoimmune disease or non-specific autoimmune manifestation (i.e. arthralgias, myalgia, malaise, fever, and weight loss), 3) detection of autoantibodies in patients' sera, 4) histological evidence of chronic inflammation and/or granulomatous reaction to foreign body.
  
  
  RESULTS
  Fifty female patients aged 44.4 ± 10 years were studied. The mean time between application of foreign substances and onset of symptoms was 4.5 ± 4.3 years. Patients were followed for 12 ± 7.5 years. Forty-one patients were injected with mineral oil, nine patients received other substances: three iodine gadital, one guayacol, one guayacol plus silicone fluid, two collagen, two silicone fluid. The sites of application were: buttocks (36), legs and/or thighs (11), breasts (eight) hands and face (one), face (two) (seven patients received an injection to more than one site). Thirty patients presented with non-specific autoimmune manifestations, whereas 20 patients fulfilled the criteria for a defined autoimmune disease such as systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, overlap syndrome, autoimmune hemolytic anemia, autoimmune thyroiditis, autoimmune hepatitis, and ulcerative colitis.
  
  
  CONCLUSIONS
  Cases of human adjuvant disease following illegal injections of oil substances for cosmetic purposes are reported. Patients presented with defined autoimmune diseases as well as with non-specific autoimmune manifestations. Illegal injection of these substances could lead to serious local and systemic complications, even to death. These cases represent another model of Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA). The use of these substances should be prohibited.
authors.affiliation: Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, México.
authors.forename: O
authors.initials: O
authors.lastname: Vera-Lastra
authors.forename: G
authors.initials: G
authors.lastname: Medina
authors.forename: M del Pilar
authors.initials: Mdel P
authors.lastname: Cruz-Dominguez
authors.forename: P
authors.initials: P
authors.lastname: Ramirez
authors.forename: J A
authors.initials: JA
authors.lastname: Gayosso-Rivera
authors.forename: H
authors.initials: H
authors.lastname: Anduaga-Dominguez
authors.forename: C
authors.initials: C
authors.lastname: Lievana-Torres
authors.forename: L J
authors.initials: LJ
authors.lastname: Jara
mesh_terms: D000277:Adjuvants, Pharmaceutic / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D003357:Cosmetic Techniques / Q000009:adverse effects* / Q000941:ethics; D005260:Female; D005547:Foreign Bodies / Q000276:immunology*; D006801:Humans; D008875:Middle Aged; D013577:Syndrome; D055815:Young Adult
chemical_list: D000277:Adjuvants, Pharmaceutic