title: Subacute fat-embolism-like syndrome following high-volume intramuscular and accidental intravascular injection of mineral oil.
abstract: OBJECTIVE
  We present a rare case of subacute fat-embolism-like syndrome (FES-like) following intravascular injection of mineral oil-steroid solution with delayed diagnosis, acute onset of pulmonary distress, and transient clinical deterioration.
  
  
  METHODS
  A 40-year-old man was admitted following as a pedestrian being hit by a car. Examinations revealed sternum fracture and lung contusion. The patient was discharged with oral analgesics. Seven days later he returned presenting with coughing, hemoptysis, elevated leucocytes, and increased C-reactive protein. Chest radiograph revealed basal infiltrations. Suspecting pneumonia, the patient was discharged with antibiotics. Unknown to the clinicians, the patient had self-administered a mineral oil with added anabolic steroids by intramuscular injections for cosmetic purposes. The patient had observed blood on aspiration, and then relocated the needle before injecting 140 ml in his biceps muscle. Shortly after, the patient described near fainting and hemoptysis suggesting an accidental intravascular injection. Over the next 3 days the patient experienced increasing shortness of breath and hemoptysis. Examinations confirmed the diagnosis and the patient was treated with organ-specific supportive measures, tranexamic acid, and prednisolone and discharged after 11 days in the hospital.
  
  
  CONCLUSIONS
  Subacute FES-like was associated with injection of body filler in muscle tissue. FES-like can mimic pneumonia, posttraumatic lung injury, and other more frequent causes to respiratory failure.
authors: Department of Anesthesiology, Bispebjerg University Hospital , Copenhagen , Denmark.
authors: Mathias
authors: M
authors: Hjort
authors: Lotte Christine Groth
authors: LC
authors: Hoegberg
authors: Merete
authors: M
authors: Almind
authors: Tejs
authors: T
authors: Jansen
mesh_terms: D000328:Adult; D045930:Anabolic Agents / Q000008:administration & dosage / Q000009:adverse effects; D057210:Delayed Diagnosis; D004620:Embolism, Fat / Q000139:chemically induced*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D019300:Medical Errors; D008899:Mineral Oil / Q000008:administration & dosage / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000139:chemically induced / Q000473:pathology; D012128:Respiratory Distress Syndrome / Q000139:chemically induced; D012646:Self Administration; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects; D014891:Weight Lifting
chemical_list: D045930:Anabolic Agents; D013256:Steroids; D008899:Mineral Oil
keywords: Adult respiratory distress syndrome; Body enhancement; Mineral oil injection