Myositis from intramuscular oil injections in a bodybuilder

Prosperi-Porta et al. and their cited references outline short- and intermediate-term toxicities of some body sculpting products.(1) Others report long-term histopathological reactions to injections of foreign substances.(2) Metabolic effects and their associations are also detailed as a more complete picture of such adversity unfolds.(3)
One lesser studied but potentially serious consequence of such injections is the longer term effect on immune dysregulation, and thereafter autoimmunity, that can potentially arise with chronic exposure to foreign products.(4,5) An autoimmune/inflammatory syndrome has been linked to foreign materials that may create adjuvancy. Some of the clinical presentations may include atypical multiple sclerosis, arthritides, possible Sjogren’s syndrome, and antiphospholipid syndromes among others. The consequences of such immune dysregulation are often insidious in onset and confuse both patient and physician. Multiple body systems may be involved, and patients are often multi-doctored as consternation arises to define the entity or causation.(4) Infamous in this regard are silicone products, some implants of which have been associated with atypical lymphomas.(4) Variable dysautonomia and peripheral neuropathy can further add to the already complicated scenario.(5)
Mast cell activation may be linked to the above and create an allergic profile that at times may mimic mastocytosis. Such activation is usually polyclonal but in its chronic form may thereafter be associated with autoimmunity. Indeed it is queried whether these phenomena are triggered by mast cell hyper-reactivity or some such.(4) Oils in particular may act as adjuvants as exemplified by incomplete Freund’s adjuvant.(4) Many pathology studies of such local reactions do not specifically detail the presence or frequency of mast cells in situ.
Society has evolved with the common obsession of fulfilling body image stereotypes. The frequency with which foreign materials are injected to accomplish those ends is not only considerable but the array of such products has also increased to match the high demand. Should long-term exposure to foreign materials lead to chronic immune stimulation and its adverse consequences, we can expect an epidemic of autoimmune or mast cell-guided pathologies. The presentation of these diseases will continue to be a major issue given the long-term nature of disease evolution. An association with solid foreign bodies can be of value since removal of the offending material can at times lead to complete or some resolution. When the product is liquid based, such as oils or related emulsions, removal is much more challenging, and there is potential for any such material to mobilize to body sites other than where the injection occurs. Anticipating these potential complications is important to clinicians since the association of multiple complex presentations with adjuvancy from foreign products will often not be understood at first glance.