Purtscher-Like Retinopathy and Diffuse Alveolar Hemorrhage Caused by Soft Tissue Injection for Gluteal Augmentation

Abstract

Purpose: To describe a rare occurrence of acute vision loss and diffuse alveolar hemorrhage following a treatment of injectable gluteal cosmetic filler. Patient and methods:A 20-year-old female underwent a cosmetic injection of unknown components for gluteal augmentation. Within hours she developed progressive shortness of breath secondary to diffuse alveolar hemorrhage. She presented to ophthalmology 6 weeks later with a history of bilateral decreased vision. Clinical examination revealed cotton wool spots and retinal hemorrhages. Fluorescein angiography demonstrated macular vascular pruning and an enlarged foveal avascular zone. Results:The patient was observed and vision did not improve after 8 months of follow-up. Conclusion:These findings were attributed to a Purtscher-like retinopathy secondary to systemic inflammation induced by the filler and/or direct microembolization of the injected material or fat. To the best of the authors' knowledge, this is the first documented case of diffuse alveolar hemorrhage and ischemic bilateral vision loss in a patient undergoing gluteal augmentation with dermal filler.

Retinal arteriole occlusions associated with microembolization following silicone gluteal injections

“…To the best of our knowledge, there are only three reports of vision loss secondary to cosmetic injection below the face, with each case presenting as Purtscher like retinopathy. 2–4 By contrast, the current patient presented with peripheral nonperfusion from presumed silicone microembolization with associated neovascularization. Given the absence of prior angiograms, the role of systemic lupus erythematosus in the peripheral nonperfusion cannot be ascertained although the presence of intraretinal silicone deposits and systemic complications of silicone embolism syndrome make the etiology of silicone microembolization more likely.…”

“…1 Three cases of vision loss presenting as Purtscher like retinopathy after nonfacial cosmetic injections have previously been described. [2][3][4] We describe a patient with retinal vascular occlusions and neovascularization associated with presumed silicone microembolization 12 years after receiving silicone gluteal injections.…”

Purtscher-Like Retinopathy and Paracentral Acute Middle Maculopathy Caused by Industrial Silicone Embolism

“…9 Pulmonary effects secondary to microembolism are the most common and serious systemic complications, with potential of death. Acute visual loss is a rare event, described by Huang et al 10 in a case report related to an unknown component of buttock injection. Khatibi 5 report a Purtscher-like retinopathy secondary to PMMA injection.…”

Purtscher-like retinopathy and paracentral acute middle maculopathy following breast filler injection

“…reported a similar case following silicone injection in both thighs and buttocks [ 11 ]. Table 1 compares our case with other cases of visual loss following non-facial filler injections [ 12 , 13 ]. To our knowledge, there were no reported cases using HA for breast tissue enhancement presenting with visual loss.…”