Streptococcus sanguinis isolated from filler granuloma: Successful treatment with incision and drainage

Abstract

Filler granuloma is considered to be the result of delayed immune responses; growing evidence suggests that they may be secondary to biofilm formation. Dermal filler is technically a foreign body, and as the development of newer generations of dermal fillers lengthens their duration, it is possible that there is also an increased risk of biofilm formation. Here, we present a case report of a patient with Streptococcus sanguinis isolated from a filler granuloma, suggestive of biofilm formation. This case demonstrates the effective use of antibiotics after incision and drainage on antibiotic resistant biofilm.

Delayed sclerosing granulomatous reaction to dermal filler injection of poly‐hydroxyethyl‐methacrylate suspended in hyaluronic acid: Histochemical and confocal laser scanning microscopical analysis

“…Many possible causes may lead to early and late granuloma formation, such as the volume of injected dermal fillers, impurities within the filler substance with biofilm formation, local infection unrelated to the filler site, and severe systemic infections with subsequent immunologic alterations . Surely, the presence of impurities may facilitate late granuloma formation, especially when including particles <20 µm in size, as phagocytosis and immunologic memory are more efficiently stimulated by smaller particles than by larger ones . Furthermore, irregularities of the particle surface, with pointed edges and corners, seem to further stimulate late granuloma formation …”

“…Also, it was postulated that macrophages would incorporate foreign particles, thus keeping the foreign particles in a latent stage. Subsequently, additional priming events (eg, supervening infections) would be needed to re‐activate macrophages, lead to multinucleated giant cell accumulation, and, finally, to fully developed granulomatous reaction . Such pathogenetic mechanism may explain the prolonged course of the disease, with only late development of clinically detectable nodular lesions.…”

No Proof that Biofilm Bacteria are Causing Dermal Filler Granulomas

“…Whether a local bacterial infection [20,21] or a systemic bacterial infection [5] can be the cause of delayed granulomas [12] remains the question. Until its proof, the present recommendation of antibiotic treatment [16][17][18] instead of corticosteroid injections [3] of cystic and sclerosing granulomas should remain a hypothesis.…”

“…The fact that the content of "cystic granulomas" [3] (Figure 2a & 2b) is most often sterile [3,21] are the base of the assumption that so-called "biofilms" must be involved, which rarely allow the detection of free "planktonic" bacteria.…”