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Case Reports

Abstract

Some cosmetic augmentation procedures do not have a happy ending. A 48-year-old female initially went to a certified plastic surgeon for a “Brazilian Butt Lift” in 2009. She was unhappy with the results, but the surgeon was not willing to operate further. Instead, she sought the help of an unknown individual, without health care training, who injected an unknown substance in order to further augment the patient’s buttocks. Over the next 10-15 years, she had a progressive reaction to the substance. Upon presentation to dermatology, the buttocks had a diffusely indurated, granulomatous appearing rash that had a rock-like consistency to palpation. A punch biopsy revealed dense fibrosis with chronic inflammation and empty vacuoles without polarizing material. No significant granulomatous reaction was identified. Unfortunately, the unknown material did not remain local. Recurrent nephrolithiasis and poor kidney function prompted a renal biopsy. The biopsy revealed numerous glomeruli and peritubular capillaries with rigid distension caused by non-refractile and weakly Oil red O positive material. Electron microscopy showed vacuoles with sharp edges within macrophages as well as similar vacuoles within the tubular lumina. This appeared consistent with the foreign substance from the buttocks. To further complicate the case, a poorly characterized systemic reaction process has continued to progress. Further workup is currently underway, and surgery is considering debriding the buttocks to remove the foreign material. This case highlights the potential systemic issues that can be caused by unsanctioned injection materials and the potential need for dermatologists to refer these patients for further care.