title: Small vessel microembolization and acute glomerulonephritis following infection of aesthetic filler implants.
abstract: BACKGROUND
  The systemic consequences of esthetic filler injections are poorly understood.
  
  
  METHODS
  We report a patient with a past history of subcutaneous injection of aesthetic filler material in the lower legs, who presented with post-infectious glomerulonephritis following necrotic leg ulcers at the injection site. Kidney biopsy revealed the presence of translucent, non-birefringent microspherical bodies compatible with polymethylmetacrylate (PMMA) microspheres in some capillary lumens. This had not previously been described. PMMA is a biphasic aesthetical filler composed of polymethylmetacrylate microspheres suspended in a biodegradable bovine collagen carrier. The solid phase (PMMA microspheres) persists in tissues for years. Although PMMA was thought to not disseminate systemically, tissue necrosis may have favored systemic dissemination of the microspheres, although entry in the circulation and microembolization at the time of administration cannot be ruled out.
  
  
  CONCLUSIONS
  In conclusion, aesthetic filler implants may cause microembolization into small vessels. Recognition of the characteristic morphology may expedite diagnosis and avoid unnecessary further testing.
authors.affiliation: Pathology, IIS-Fundacion Jimenez Diaz, School of Medicine, UAM, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Cannata-Ortiz
authors.affiliation: Nephrology and REDINREN, IIS-Fundacion Jimenez Diaz, School of Medicine, UAM, Madrid, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Gracia
authors.affiliation: Nephrology and REDINREN, IIS-Fundacion Jimenez Diaz, School of Medicine, UAM, Madrid, Spain.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Aouad
authors.affiliation: Pathology, IIS-Fundacion Jimenez Diaz, School of Medicine, UAM, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Barat
authors.affiliation: Pathology, 12 Octubre Hospital, Madrid, Spain.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Martinez-Gonzalez
authors.affiliation: Nephrology and REDINREN, IIS-Fundacion Jimenez Diaz, School of Medicine, UAM, Madrid, Spain.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rossello
authors.affiliation: Nephrology and REDINREN, IIS-Fundacion Jimenez Diaz, School of Medicine, UAM, Madrid, Spain.
authors.forename: Catalina
authors.initials: C
authors.lastname: Martin-Cleary
authors.affiliation: Nephrology and REDINREN, IIS-Fundacion Jimenez Diaz, School of Medicine, UAM, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Fernández-Fernández
authors.affiliation: Dermatology, IIS-Fundacion Jimenez Diaz, School of Medicine, UAM, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Requena
authors.affiliation: Nephrology and REDINREN, IIS-Fundacion Jimenez Diaz, School of Medicine, UAM, Madrid, Spain. aortiz@fjd.es.|IRSIN, Madrid, Spain. aortiz@fjd.es.|Laboratory of Nephrology, IIS-Fundacion Jimenez Diaz, Avda Reyes Catolicos 2, 28040, Madrid, Spain. aortiz@fjd.es.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ortiz
mesh_terms: D000208:Acute Disease; D001672:Biocompatible Materials; D001706:Biopsy; D003357:Cosmetic Techniques / Q000009:adverse effects*; D000067548:Dermal Fillers / Q000008:administration & dosage / Q000009:adverse effects*; D004617:Embolism / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005455:Fluorescent Antibody Technique; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005921:Glomerulonephritis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007279:Injections, Subcutaneous; D008863:Microspheres; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000008:administration & dosage / Q000009:adverse effects*; D011237:Predictive Value of Tests; D013290:Streptococcal Infections / Q000150:complications
chemical_list: D001672:Biocompatible Materials; D000067548:Dermal Fillers; D019904:Polymethyl Methacrylate