Majocchi's granuloma caused by Trichophyton rubrum after facial injection with hyaluronic acid: A case report

Abstract

BACKGROUND Facial cosmetic procedures become popular for people with a desire to have a younger appearance, and cosmetic technology has developed rapidly over the past several decades. However, increasing complications related to cosmetic injections have been reported, and infection is one of the most serious problems and can cause anxiety and facial injury. We here report a case of Majocchi's granuloma (MG) caused by Trichophyton rubrum after facial injection of hyaluronic acid. CASE SUMMARY A 37-year-old woman presented to our hospital with a history of red papules, nodules, and abscesses on her left zygomatic arch for 2 mo. She had received a cosmetic injection of hyaluronic acid on the left side of her face prior to the appearance of the lesions. MG caused by Trichophyton rubrum after facial injection of hyaluronic acid was diagnosed based on morphology and molecular biological identification. In vitro antifungal susceptibility testing was conducted according to the Clinical and Laboratory Standards Institute M38-A2 method. Minimal inhibitory concentrations were used to evaluate the antifungal susceptibility. The antifungal agents and their minimal inhibitory concentrations for the strain were terbinafine (< 0.5 μg/mL), itraconazole (0.06 μg/mL), amphotericin B (0.25 μg/mL), fluconazole (32 μg/mL), voriconazole (0.125 μg/mL), posaconazole (0.125 μg/mL), and isavuconazole (0.06 μg/mL). We initially administered 250 mg/d oral terbinafine for 2 mo, but the patient still had painful papules, nodules and abscesses on her face. Then, we adjusted the treatment to itraconazole 400 mg/d for 8 wk based on the in vitro antifungal susceptibility testing results. The skin lesions improved significantly, and there was no recurrence during follow-up. CONCLUSION This case revealed that facial injection of hyaluronic acid may cause serious MG. Antifungal susceptibility testing should be considered in the treatment of MG caused by Trichophyton rubrum .

Are Delayed Dermal Filler Granulomas More Common Since COVID-19?

“…Both BDDE and low molecular weight hyaluronic acid are pro-inflammatory. 17 It is hypothesized that normal breakdown of the product over time leads to release of low molecular weight hyaluronic acid precipitating delayed granuloma formation. 17 …”

“…Delayed HA granulomas have a variety of causes. 1 , 2 , 3 , 4 , 5 , 6 , 8 , 9 , 10 , 11 , 13 , 14 , 15 , 17 , 18 , 19 , 20 , 21 , 22 , 24 Anecdotal evidence brought a new concern with the COVID pandemic – the effect of COVID infection or vaccination on the development of granulomas. This retrospective cohort of the senior author’s practice shows that there was a statistical increase in the development of HA granulomas during the COVID pandemic.…”

“…1 , 2 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 13 , 14 Granulomas are characterized by erythema, induration, and edema and can be caused by bacterial or fungal contamination and breakdown of proprietary ingredients or modified HA. 1 , 10 , 11 , 17 “Vycross” cross-linking technology by Allergan uses butanediol diglycidyl ether (BDDE) and small molecular weight HA in its proprietary formula. Both chemicals are pro-inflammatory and may be related to late granuloma formation.…”

Natural Compounds with Antimicrobial Properties in Cosmetics

“…The use of cosmetics may be associated with a risk of contracting dermatophyte infections. Liu et al presented a case report on Majocchi’s granuloma (MG) caused by Trichophyton rubrum after facial hyaluronic acid injection [ 47 ]. As indicated by the authors, consumers are most concerned about such complications as infections and facial damage associated with injections of cosmetic products.…”

Antifungal Drugs TDM: Trends and Update

“…AF TDM cases in real-life settings (pathogens, underlying diseases, 69,71–73,75,81 trends per year, 84,234,235,236,238,239,241,244,245,344–348 CNS 532–539 localization 541–566 ) 364,370,499,522,527–530 Trends are concerning a majority of mucomycosis and aspergillosis, in oncohematology and transplantation. VRZ, more recently PSZ tablets and ISZ are the most represented.…”