Case and Research Letters
Sarcoid Granulomas in Facial Cosmetic Filler Material: Induction by Interferon-α and Ribavirin in a Patient with Hepatitis C
Granulomas sarcoideos en material de relleno facial inducidos por interferón α y ribavirina en paciente con hepatitis C
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López-Pestaña, A. Tuneu, C. Lobo, J. Zubizarreta" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "López-Pestaña" "email" => array:1 [ 0 => "aranlop13@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Tuneu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Lobo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Zubizarreta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Donostia, San Sebastián, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Donostia, San Sebastián, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Granulomas sarcoideos en material de relleno facial inducidos por interferón α y ribavirina en paciente con hepatitis C" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 714 "Ancho" => 952 "Tamanyo" => 201029 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Sarcoid granulomas surrounding optically empty vacuolar structures (hematoxylin-eosin, original magnification ×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cutaneous adverse effects of interferon are common, including particularly injection site reactions, alopecia, stomatitis, pruritus, and flare-ups of psoriasis, eczema, or lichen planus.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Interferon-induced sarcoidosis is a lesser-known adverse effect that may affect 0.2% of patients.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The first case of this condition was reported in 1987 in a patient receiving interferon for renal carcinoma<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and the first case secondary to treatment for hepatitis C was published in 1993.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Since then many cases of interferon-induced sarcoidosis have been reported.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 56-year-old woman who presented with facial lesions that had appeared a month earlier. The patient's history included hepatitis C diagnosed in 2002, for which she had started treatment with pegylated interferon alfa-2b and ribavirin in October 2003. Three months after starting treatment she developed progressive facial edema, so the treatment was discontinued. During the following month the edema gradually remitted and violaceous nodular lesions appeared in the nasolabial folds and on the upper lip and forehead, coinciding with the areas injected with cosmetic filler material, including Artecoll (polymethylmethacrylate microspheres suspended in a 3.5% solution of collagen) 14 and 4 years earlier (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). Skin biopsy revealed in the dermis the presence of epithelioid granulomas with multinucleated giant cells surrounding optically empty vacuolar structures of various sizes (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).The following relevant results were observed in the blood tests: aspartate aminotransferase, 60 U/L; alanine aminotransferase, 79 U/L; angiotensin converting enzyme, 145 U/L (normal range, 0-115 U/L). A Mantoux test was negative and a chest radiograph normal. In the absence of other systemic symptoms, no more tests were performed. We established the diagnosis of sarcoidosis induced by interferon and ribavirin, with granulomas in the areas injected with filler material. The patient decided to discontinue the antiviral treatment definitively and the lesions regressed spontaneously in 6 months.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Our first approach was to determine whether the patient was suffering from foreign body granulomas or sarcoidosis lesions, because traditionally the presence of foreign material in epithelioid granulomas excludes the latter diagnosis. However, it is now thought that in sarcoidosis the immune system's ability to eliminate foreign material is altered, so the foreign material acts as a focus for the location of granulomas.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although the patient was told that the filler material was Artecoll, the presence of vacuoles of various sizes in the biopsy suggests the presence of silicone, because the granulomas induced by Artecoll usually have vacuoles of a more uniform size.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Although the first reported case of sarcoidosis associated with hepatitis C occurred during treatment with interferon,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> this condition has also been reported in untreated individuals, so it is postulated that hepatitis C could also favor its development. In a study of 68 patients with hepatitis C and sarcoidosis by Ramos-Casals et al,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> antiviral treatment proved to be the trigger in 75% of cases. With regard to the pathogenic mechanism, there is a predominantly T helper 1 (Th1) response in sarcoidosis that is very active against a variety of exogenous antigens or autoantigens. By favoring the differentiation of T helper cells towards the Th1 type, interferon could induce the onset of the disease. In addition, ribavirin may act as a cofactor because it also stimulates the Th1 response.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Interferon-induced sarcoidosis is more common in middle-aged women, usually appearing during the first 6 months of treatment. It mainly affects the lungs and skin. Skin lesions have been reported in 60% of the patients, sometimes around foreign bodies<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> or on filler material.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> The prognosis is generally good, with spontaneous improvement after cessation of treatment.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the literature review we found 4 cases of sarcoidosis with granulomas in areas injected with filler materials.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a> All patients were women: one had pulmonary sarcoidosis<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and in the other 3 the disease appeared after interferon and ribavirin treatment for hepatitis C.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> The fillers were hyaluronic acid,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> silicone,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and Artecoll<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,10</span></a> and they had been injected 2 to 10 years earlier. In the 3 cases induced by interferon, treatment was not discontinued: in 2 cases oral corticosteroids were administered<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and in 1 case allopurinol<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>; the lesions improved in all 3 cases. Therefore, the therapeutic approach to interferon-induced sarcoidosis depends on the severity of the disease. If there is no significant systemic involvement, the therapy can be maintained with suitable follow-up and treatment.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, because the use of cosmetic filler materials is growing, it is likely that more cases like ours will be diagnosed in the future. We suggest requesting hepatitis C serology, asking the patients about a possible past history of sarcoidosis, and warning of this potential adverse effect prior to injection with filler material.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: López-Pestaña A, et al. Granulomas sarcoideos en material de relleno facial inducidos por interferon α y ribavirina en pacientes con hepatitis C. Actas Dermosifiliogr.2011;102:746-747.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 574 "Ancho" => 899 "Tamanyo" => 90196 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Violaceous linear plaques on the forehead.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 680 "Ancho" => 952 "Tamanyo" => 95885 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Infiltrated plaques in the nasolabial folds and on the upper lip.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 714 "Ancho" => 952 "Tamanyo" => 201029 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Sarcoid granulomas surrounding optically empty vacuolar structures (hematoxylin-eosin, original magnification ×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of adverse cutaneous drug reactions resulting from the use of interferon and ribavirin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 10 | 16 |
| 2024 Octubre | 86 | 41 | 127 |
| 2024 Septiembre | 79 | 25 | 104 |
| 2024 Agosto | 114 | 47 | 161 |
| 2024 Julio | 110 | 38 | 148 |
| 2024 Junio | 103 | 42 | 145 |
| 2024 Mayo | 116 | 31 | 147 |
| 2024 Abril | 88 | 23 | 111 |
| 2024 Marzo | 105 | 36 | 141 |
| 2024 Febrero | 94 | 32 | 126 |
| 2024 Enero | 73 | 28 | 101 |
| 2023 Diciembre | 87 | 15 | 102 |
| 2023 Noviembre | 114 | 25 | 139 |
| 2023 Octubre | 75 | 11 | 86 |
| 2023 Septiembre | 118 | 24 | 142 |
| 2023 Agosto | 74 | 26 | 100 |
| 2023 Julio | 92 | 27 | 119 |
| 2023 Junio | 86 | 21 | 107 |
| 2023 Mayo | 125 | 21 | 146 |
| 2023 Abril | 121 | 17 | 138 |
| 2023 Marzo | 117 | 16 | 133 |
| 2023 Febrero | 107 | 21 | 128 |
| 2023 Enero | 92 | 27 | 119 |
| 2022 Diciembre | 64 | 45 | 109 |
| 2022 Noviembre | 60 | 22 | 82 |
| 2022 Octubre | 64 | 19 | 83 |
| 2022 Septiembre | 46 | 36 | 82 |
| 2022 Agosto | 40 | 62 | 102 |
| 2022 Julio | 40 | 82 | 122 |
| 2022 Junio | 50 | 29 | 79 |
| 2022 Mayo | 58 | 40 | 98 |
| 2022 Abril | 80 | 41 | 121 |
| 2022 Marzo | 72 | 60 | 132 |
| 2022 Febrero | 96 | 32 | 128 |
| 2022 Enero | 93 | 33 | 126 |
| 2021 Diciembre | 75 | 41 | 116 |
| 2021 Noviembre | 74 | 40 | 114 |
| 2021 Octubre | 78 | 40 | 118 |
| 2021 Septiembre | 68 | 37 | 105 |
| 2021 Agosto | 102 | 20 | 122 |
| 2021 Julio | 61 | 23 | 84 |
| 2021 Junio | 59 | 28 | 87 |
| 2021 Mayo | 54 | 38 | 92 |
| 2021 Abril | 129 | 51 | 180 |
| 2021 Marzo | 71 | 23 | 94 |
| 2021 Febrero | 61 | 21 | 82 |
| 2021 Enero | 41 | 19 | 60 |
| 2020 Diciembre | 53 | 13 | 66 |
| 2020 Noviembre | 30 | 11 | 41 |
| 2020 Octubre | 33 | 11 | 44 |
| 2020 Septiembre | 51 | 11 | 62 |
| 2020 Agosto | 31 | 13 | 44 |
| 2020 Julio | 21 | 14 | 35 |
| 2020 Junio | 43 | 29 | 72 |
| 2020 Mayo | 24 | 17 | 41 |
| 2020 Abril | 41 | 23 | 64 |
| 2020 Marzo | 43 | 26 | 69 |
| 2020 Febrero | 3 | 2 | 5 |
| 2019 Diciembre | 2 | 4 | 6 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 3 | 1 | 4 |
| 2019 Agosto | 0 | 2 | 2 |
| 2019 Julio | 0 | 2 | 2 |
| 2019 Junio | 2 | 0 | 2 |
| 2019 Mayo | 1 | 17 | 18 |
| 2019 Abril | 0 | 3 | 3 |
| 2019 Marzo | 2 | 9 | 11 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Noviembre | 2 | 1 | 3 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 1 | 2 | 3 |
| 2018 Agosto | 0 | 8 | 8 |
| 2018 Julio | 0 | 5 | 5 |
| 2018 Junio | 0 | 3 | 3 |
| 2018 Mayo | 0 | 7 | 7 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 18 | 2 | 20 |
| 2018 Febrero | 46 | 8 | 54 |
| 2018 Enero | 92 | 8 | 100 |
| 2017 Diciembre | 94 | 14 | 108 |
| 2017 Noviembre | 78 | 8 | 86 |
| 2017 Octubre | 62 | 15 | 77 |
| 2017 Septiembre | 87 | 8 | 95 |
| 2017 Agosto | 88 | 15 | 103 |
| 2017 Julio | 90 | 4 | 94 |
| 2017 Junio | 108 | 23 | 131 |
| 2017 Mayo | 96 | 10 | 106 |
| 2017 Abril | 89 | 20 | 109 |
| 2017 Marzo | 86 | 37 | 123 |
| 2017 Febrero | 73 | 14 | 87 |
| 2017 Enero | 64 | 18 | 82 |
| 2016 Diciembre | 105 | 16 | 121 |
| 2016 Noviembre | 87 | 27 | 114 |
| 2016 Octubre | 96 | 10 | 106 |
| 2016 Septiembre | 75 | 10 | 85 |
| 2016 Agosto | 86 | 24 | 110 |
| 2016 Julio | 62 | 6 | 68 |
| 2016 Junio | 9 | 7 | 16 |
| 2016 Mayo | 14 | 9 | 23 |
| 2016 Abril | 7 | 14 | 21 |
| 2016 Marzo | 13 | 10 | 23 |
| 2016 Febrero | 9 | 1 | 10 |
| 2016 Enero | 11 | 16 | 27 |
| 2015 Diciembre | 8 | 4 | 12 |
| 2015 Noviembre | 30 | 9 | 39 |
| 2015 Octubre | 41 | 2 | 43 |
| 2015 Septiembre | 12 | 11 | 23 |
| 2015 Agosto | 7 | 3 | 10 |
| 2015 Julio | 97 | 10 | 107 |
| 2015 Junio | 53 | 11 | 64 |
| 2015 Mayo | 81 | 18 | 99 |
| 2015 Abril | 76 | 12 | 88 |
| 2015 Marzo | 69 | 18 | 87 |
| 2015 Febrero | 71 | 12 | 83 |
| 2015 Enero | 64 | 17 | 81 |
| 2014 Diciembre | 73 | 10 | 83 |
| 2014 Noviembre | 50 | 18 | 68 |
| 2014 Octubre | 61 | 11 | 72 |
| 2014 Septiembre | 54 | 13 | 67 |
| 2014 Agosto | 47 | 14 | 61 |
| 2014 Julio | 57 | 17 | 74 |
| 2014 Junio | 54 | 13 | 67 |
| 2014 Mayo | 78 | 14 | 92 |
| 2014 Abril | 55 | 6 | 61 |
| 2014 Marzo | 65 | 18 | 83 |
| 2014 Febrero | 28 | 17 | 45 |
| 2014 Enero | 38 | 13 | 51 |
| 2013 Diciembre | 42 | 12 | 54 |
| 2013 Noviembre | 36 | 16 | 52 |
| 2013 Octubre | 15 | 5 | 20 |
| 2013 Septiembre | 25 | 10 | 35 |
| 2013 Agosto | 13 | 12 | 25 |
| 2013 Julio | 10 | 26 | 36 |
| 2013 Junio | 20 | 19 | 39 |
| 2013 Mayo | 16 | 15 | 31 |
| 2013 Abril | 11 | 9 | 20 |
| 2013 Marzo | 15 | 11 | 26 |
| 2013 Febrero | 31 | 8 | 39 |
| 2013 Enero | 43 | 8 | 51 |
| 2012 Diciembre | 14 | 3 | 17 |
| 2012 Julio | 1 | 0 | 1 |
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