Severe life-threatening hypersensitivity reaction to polidocanol in a case of recurrent aneurysmal bone cyst

Abstract

Aneurysmal bone cysts (ABC) are expansile lytic lesions constituting around 1% of all benign bone tumors with an annual incidence of 1.4/100000. A variety of treatments are available ranging from curettage with or without bone grafting (autologous or allogeneic), curettage with use of adjuvants [Polymethylmethacrylate (PMMA) bone cement, high speed burr, phenol, liquid nitrogen], wide en-block excision with or without reconstruction, selective arterial embolization of the feeding vessels, radiation therapy, high precision megavoltage radiotherapy and percutaneous radio-nuclide ablation, sclerotherapy (ethibloc, aetoxisclerol, alcohol gel, polidocanol). The optimal treatment is debatable due to various indications and contraindications of different modalities of treatment. Recent data suggest that percutaneous sclerotherapy with polidocanol is safe and effective alternative to surgery for treatment of ABCs as it has minimal side effects. We are reporting the first case of life-threatening adverse reaction to intralesional polidocanol in a three-year-old boy with a proximal femoral aneurysmal bone cyst. The importance of reporting this case is to make people aware regarding the adverse reaction of polidocanol and to highlight the precautions one should follow while using polidocanol for aneurysmal bone cysts.

Effectiveness and safety of ultrasound-guided intramuscular lauromacrogol injection combined with hysteroscopy in cervical pregnancy treatment: A case report

“…It is important in sclerotherapy, as it can cause sterile inflammation with the groups which can help obtain protein precipitation in several seconds and thus cause damage to the lipid bilayer of the cell membrane, thereby leading to fibrous tissue hyperplasia and adhesions[ 17 , 18 ]. In addition, it has great applications in digestive, cardiovascular, and nervous system diseases[ 19 , 20 ]. However, there is a paucity of reports on lauromacrogol as a hemostatic agent in ectopic pregnancy.…”

Treatment of aneurysmal bone cysts using polidocanol: Is it useful?

“…Varicose veins, oesophageal hemorrhage brought on by varices, intestinal vascular malformations, telangiectases, and venous malformations of the head, neck, and limbs have all been successfully treated with the sclerosant polidocanol [13,23,24] . Additionally, polidocanol has been utilized as an ointment-based local anesthetic and antipruritic [25] . Without experiencing any negative side effects, polidocanol has been used safely to treat ABC of the skeletal system.…”

Sclerotherapy for Aneurysmal Bone Cyst: A Single-Center Experience

“…Polidocanol, a sclerosant, has been used safely to treat varicose veins, oesophageal bleeding due to varices, intestinal vascular malformations, telangiectases, and venous malformations of the head, neck, and limbs [16,[26][27]. Polidocanol has also been used as a local anesthetic and antipruritic agent in ointment form [28]. Polidocanol has been used safely to treat ABC of the skeletal system without any severe side effects.…”

“…Polidocanol has been used safely to treat ABC of the skeletal system without any severe side effects. However, Gupta et al reported a life-threatening adverse event with an intralesional application of polidocanol in managing recurrent ABC of the proximal femur in a three-year-old child, so it is recommended to perform sclerotherapy procedure in the operation theater with proper anesthesia support so as to tackle any adverse reaction [ 28 ].…”