Foreign body reaction triggered by cytotoxic T lymphocyte-associated protein 4 blockade 25 years after dermal filler injection

Abstract

Foreign body reactions are regularly seen as a late complication of cosmetic treatment with synthetic dermal fillers. Often this foreign body reaction is triggered by a systemic infection, but other systemic triggers are also reported. In this case report, we present a woman in her 60s who was treated with ipilimumab for metastatic melanoma. After two courses of treatment she developed painless facial nodules. A foreign body reaction to dermal fillers was suspected because the patient had received cosmetic treatment with dermal fillers 25 years previously. This reaction was confirmed by excision and histological examination. In the absence of other known triggers, this case revealed immunotherapy (ipilimumab) and subsequent activation of the adaptive immune system as potential triggers of foreign body reactions to dermal fillers. Immunotherapy is increasingly used as anticancer treatment for an increasing number of tumour types. Furthermore, synthetic dermal fillers have frequently been used in the past. Therefore, physicians should be aware of this late-occurring complication of synthetic filler treatment in patients who develop skin lesions during immunotherapy.

Reopening the case for case reports

“…Bisschop et al reported a case of malignant melanoma treated with ipilimumab in which the patient developed a foreign body granulomatous reaction during immunotherapy 25 years after the injection of permanent synthetic fillers. 9 A reaction thought to be precipitated by activation of the adaptive immune system during cytotoxic T lymphocyte-associated protein-4 blockade. Given the ever-increasing use of both checkpoint inhibitors and cosmetic fillers this may represent the first of many such cases.…”

“…6 HS is associated with elevated body mass index with obesity possibly contributing to HS disease severity. 7 The patient 5 The treatment of hidradenitis suppurativa with the glucagon-like peptide-1 agonist liraglutide 6 Describe new adverse effects of therapies Vemurafenib-induced toxic epidermal necrolysis: possible cross-reactivity with other sulfonamide compounds 8 Foreign body reaction triggered by cytotoxic T lymphocyte-associated protein 4 blockade 25 years after dermal filler injection 9 Paradoxical ulcerative colitis during adalimumab treatment of psoriasis 10 Lichenoid drug eruption induced by an infliximab biosimilar 11…”

A sting in the tail: filler nodules after monoclonal antibody treatment

“…In their case report, Bisschop et al . describe a patient in whom ipilimumab elicited a typical granulomatous reaction, necessitating surgical removal of inflammatory nodules . The filler compound (most probably silicone oil) mentioned in this case belongs to a group of minimally biodegradable filler products, known to have a notoriously high incidence of resultant immunological reactions…”

“…The clearly written case report by Bisschop et al ., in this issue of the BJD , describes a granulomatous reaction as a late complication of a minimally biodegradable filler . This foreign body reaction triggered by a cytotoxic T‐lymphocyte‐associated (CTLA)‐4 blocking monoclonal antibody was seen decades after the probable injection of silicone oil as a soft tissue filler.…”

Dermal Filler Injections Mimic Tumor Activity during Immune Checkpoint Inhibition

“…We interpret the subcutaneous FDG uptake as a nivolumab-related foreign body reaction to the dermal filler. Foreign body reactions following dermal filler can be triggered by systemic infections, drugs or immunotherapy [2][3][4]. One case report describes a foreign body reaction during ipilimumab for malignant melanoma [2], but to date there are no reports of comparable reactions during nivolumab.…”