Human adjuvant disease induced by foreign substances: a new model of ASIA (Shoenfeld's syndrome)
O Vera-Lastra1,2
G Medina1,2
M del Pilar Cruz-Dominguez1,2
P Ramirez1
JA Gayosso-Rivera1
H Anduaga-Dominguez1
C Lievana-Torres1
LJ Jara1,2⇓
1Hospital de Especialidades Centro M?dico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, M?xico;
2Universidad Nacional Aut?noma de M?xico, Mexico City, Mexico.
Luis J. Jara, Hospital de Especialidades ?Dr. Antonio Fraga Mouret? Centro M?dico La Raza. Seris Zaachila s/n Colonia La Raza, Mexico City, ZC: 02990
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Abstract
Objective: To investigate the clinical, laboratory and histological manifestations of patients who received illegal injections of foreign substances for cosmetic purposes.
Patients and methods: We studied patients who met the following inclusion criteria: 1) history of application of foreign substances for cosmetic purposes, 2) clinical data of autoimmune disease or non-specific autoimmune manifestation (i.e. arthralgias, myalgia, malaise, fever, and weight loss), 3) detection of autoantibodies in patients? sera, 4) histological evidence of chronic inflammation and/or granulomatous reaction to foreign body.
Results: Fifty female patients aged 44.4 ? 10 years were studied. The mean time between application of foreign substances and onset of symptoms was 4.5 ? 4.3 years. Patients were followed for 12 ? 7.5 years. Forty-one patients were injected with mineral oil, nine patients received other substances: three iodine gadital, one guayacol, one guayacol plus silicone fluid, two collagen, two silicone fluid. The sites of application were: buttocks (36), legs and/or thighs (11), breasts (eight) hands and face (one), face (two) (seven patients received an injection to more than one site). Thirty patients presented with non-specific autoimmune manifestations, whereas 20 patients fulfilled the criteria for a defined autoimmune disease such as systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, overlap syndrome, autoimmune hemolytic anemia, autoimmune thyroiditis, autoimmune hepatitis, and ulcerative colitis.
Conclusions: Cases of human adjuvant disease following illegal injections of oil substances for cosmetic purposes are reported. Patients presented with defined autoimmune diseases as well as with non-specific autoimmune manifestations. Illegal injection of these substances could lead to serious local and systemic complications, even to death. These cases represent another model of Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA). The use of these substances should be prohibited.
