Abstract

“Lipodissolve” is a non-FDA approved solution of phosphatidylcholine in deoxycholate that was developed around 2004. A study of its’ safety reported minor and uncommon side effects including pain, tender nodules, pigmentary alterations, and ulceration. We present a 53-year-old female who received “Lipodissolve” injections bilaterally to her proximal arms. One week later she developed painful nodules at each injection site. She was treated with a 10-day course of trimethoprim/sulfamethoxazole without improvement. An incisional biopsy was performed and showed deep dermal suppurative inflammation with numerous neutrophils and granulomas. Stains for bacteria, fungus and acid fast organisms were negative. Cultures for acid fast bacilli grew Mycobacterium abscessus, sensitive only to amikacin. The patient was subsequently treated with intravenous Amikacin with symptom resolution. Investigation revealed that similar infections were linked to Lipodissolve injections originating from the same physician’s office The most common organism implicated in injection infections is Staphylococcus aureus. Infections at injection sites caused by atypical mycobacteria have been reported to occur following tattooing, other types of injections and implants. Of atypical mycobacteria, the M. chelone subspecies abscessus accounts for the greatest number of post injection or iatrogenic infections. Common anti-tubercular drugs are not effective for treating atypical mycobacteria, making species identification and sensitivity testing imperative for treatment. This case highlights an unusual infection caused by cosmetic injections of “Lipodissolve”, previously reported to be associated with minimal side effects, and the importance of examination for acid fast bacilli and follow up with culture, even in the absence of organisms identified on stained sections.

Financial Disclosure:
No current or relevant financial relationships exist.