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Practice

Myositis from intramuscular oil injections in a bodybuilder

Graeme Prosperi-Porta, Christopher Oleynick and Stephen Vaughan
CMAJ May 04, 2020 192 (18) E480; DOI: https://doi.org/10.1503/cmaj.191500
Graeme Prosperi-Porta
Cumming School of Medicine, Department of Medicine (Prosperi-Porta, Oleynick, Vaughan), University of Calgary, Calgary, Alta.; Division of Infectious Diseases, Department of Medicine (Vaughan), Foothills Medical Centre, Calgary, Alta.
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Christopher Oleynick
Cumming School of Medicine, Department of Medicine (Prosperi-Porta, Oleynick, Vaughan), University of Calgary, Calgary, Alta.; Division of Infectious Diseases, Department of Medicine (Vaughan), Foothills Medical Centre, Calgary, Alta.
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Stephen Vaughan
Cumming School of Medicine, Department of Medicine (Prosperi-Porta, Oleynick, Vaughan), University of Calgary, Calgary, Alta.; Division of Infectious Diseases, Department of Medicine (Vaughan), Foothills Medical Centre, Calgary, Alta.
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  • RE: Resection of oil injection fillers is definitive treatment for recurrent inflammatory complication.
    Kate Elzinga [MD] and J. Preston Wiley [MPE, MD]
    Posted on: 03 December 2020
  • RE: Taking a Long-Term View of Body Sculpting Products
    Nevio Cimolai [MD,FRCP(C)]
    Posted on: 16 October 2020
  • Posted on: (3 December 2020)
    Page navigation anchor for RE: Resection of oil injection fillers is definitive treatment for recurrent inflammatory complication.
    RE: Resection of oil injection fillers is definitive treatment for recurrent inflammatory complication.
    • Kate Elzinga [MD], Clinical Lecturer and Plastic Surgeon, Department of Surgery, Section of Plastic Surgery
    • Other Contributors:
      • J. Preston Wiley, Clinical Professor and Sport and Exercise Medicine Physician

    The case report in the ‘Practice’ section by Prosperi-Porta et al1 highlights a common problem related to the use of ‘fillers’ to increase or sculpt muscle size/definition. It was disappointing to read that the case was not complete, in that discussion on surgical management and outcome was not properly reported. Treatment with tetracycline antibiotics (ex. minocycline, doxycycline), steroids (ex. prednisone, prednisolone), and immune-modulating medications (ex. etanercept) can be trialed.2 Resection, for well-circumscribed foreign materials, is the definitive treatment for ongoing inflammatory response related to this injected foreign body.
    In this case resection was successful. The foreign material was excised from the bilateral anterior upper arms, from within the subcutaneous fat and superficial biceps brachii muscles. Pathology of the specimens removed added no new information to that reported. The patient has had no further episodes of localized inflammation of the biceps since surgery 10 months ago.
    In areas of the body that are easily seen, surgical resection can leave scars and contour deformities that can be disturbing to the individual. A recent article by Sharobaro et al3 highlights this problem. Patient education regarding the long term complications of injectable materials is imperative. As seen in the patient reported by Prosperi-Porta et al, chronic inflammation, pain, and impairment can result from fillers. Surgical resection can be per...

    Show More

    The case report in the ‘Practice’ section by Prosperi-Porta et al1 highlights a common problem related to the use of ‘fillers’ to increase or sculpt muscle size/definition. It was disappointing to read that the case was not complete, in that discussion on surgical management and outcome was not properly reported. Treatment with tetracycline antibiotics (ex. minocycline, doxycycline), steroids (ex. prednisone, prednisolone), and immune-modulating medications (ex. etanercept) can be trialed.2 Resection, for well-circumscribed foreign materials, is the definitive treatment for ongoing inflammatory response related to this injected foreign body.
    In this case resection was successful. The foreign material was excised from the bilateral anterior upper arms, from within the subcutaneous fat and superficial biceps brachii muscles. Pathology of the specimens removed added no new information to that reported. The patient has had no further episodes of localized inflammation of the biceps since surgery 10 months ago.
    In areas of the body that are easily seen, surgical resection can leave scars and contour deformities that can be disturbing to the individual. A recent article by Sharobaro et al3 highlights this problem. Patient education regarding the long term complications of injectable materials is imperative. As seen in the patient reported by Prosperi-Porta et al, chronic inflammation, pain, and impairment can result from fillers. Surgical resection can be performed to remove localized foreign bodies, but can lead to permanent, non-correctable secondary aesthetic deformities. Excision is not technically possible for patients with extensive fillers and/or resultant granulomas.4,5

    Show Less
    Competing Interests: None declared.

    References

    • 1. Graeme Prosperi-Porta, Christopher Oleynick, Stephen Vaughan. Myositis from intramuscular oil injections in a bodybuilder. CMAJ 2020;192:E480-E480.
    • 2. Singh, Mansher MD; Solomon, Isaac H. MD, PhD; Calderwood, Michael S. MD, MPH; Talbot, Simon G. MD Silicone-induced Granuloma After Buttock Augmentation, Plastic and Reconstructive Surgery - Global Open: February 2016 - Volume 4 - Issue 2 - p e624 doi:
    • 3. Sharobaro VI, Manturova NE, Ivanov YV, Avdeev AE, Zabozlaev FG, Telnova AV. [Injected non-absorbable fillers in large volumes]. [in Russian] Khirurgiia (Mosk). 2019;(4):42-51. doi:10.17116/hirurgia201904142, 10.17116/hirurgia201904142
    • 4. Crocco E, Pascini M, Suzuki N, Alves R, Proença T, Lellis R. Minocycline for the treatment of cutaneous silicone granulomas: A case report. J Cosmet Laser Ther. 2016;18(1):48-9. doi: 10.3109/14764172.2015.1052514. Epub 2016 Jan 25.
    • 5. Paul S, Goyal A, Duncan LM, Smith GP. Granulomatous reaction to liquid injectable silicone for gluteal enhancement: review of management options and success of doxycycline. Dermatol Ther. 2015 Mar-Apr;28(2):98-101. doi: 10.1111/dth.12204. Epub 2015
  • Posted on: (16 October 2020)
    Page navigation anchor for RE: Taking a Long-Term View of Body Sculpting Products
    RE: Taking a Long-Term View of Body Sculpting Products
    • Nevio Cimolai [MD,FRCP(C)], Physician, Faculty of Medicine, The University of British Columbia

    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...

    Show More

    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.

    Show Less
    Competing Interests: None declared.

    References

    • 1. Prosperi-Porta G, Oleynick C, Vaughan S. Myositis from intramuscular oil injections in a bodybuilder. CMAJ 2020;192:E480.
    • 2. AbdulGaffar B. Illicit injections in bodybuilders: a clinicopathological study of 11 cases in 9 patients with a spectrum of histological reaction patterns. Int J Surg Pathol 2014;22(8):688-94.
    • 3. Eldrup E, Theilade S, Lorenzen M, et al. Hypercalcemia after cosmetic oil injections : unraveling etiology, pathogenesis, and severity. J Bone Miner Res 2020 Sep 15. doi : 10.1002/jbmr.4179.
    • 4. Cimolai N. Mast cell biology and linkages for non-clonal mast cell activation syndrome and autoimmune/inflammatory syndrome induced by adjuvants. SN Comp Clin Med 2020 Oct. doi: 10.1007/s423399-020-00494-8.
    • 5. Cimolai N. Mast cell biology in the context of dysautonomia and neuropathy. Clin Immunol 2020;215:108417.
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Canadian Medical Association Journal: 192 (18)
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Vol. 192, Issue 18
4 May 2020
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Myositis from intramuscular oil injections in a bodybuilder
Graeme Prosperi-Porta, Christopher Oleynick, Stephen Vaughan
CMAJ May 2020, 192 (18) E480; DOI: 10.1503/cmaj.191500

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Myositis from intramuscular oil injections in a bodybuilder
Graeme Prosperi-Porta, Christopher Oleynick, Stephen Vaughan
CMAJ May 2020, 192 (18) E480; DOI: 10.1503/cmaj.191500
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