A case of cutaneous necrosis due to intra-articular hyaluronic acid and treated with hyaluronidase

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Abstract

A 66-year-old woman presented to the hospital with cutaneous necrosis of her right ankle and foot. Her symptoms began immediately after an intra-articular injection of hyaluronic acid for ankle osteoarthritis, which was performed 6 days before. Histopathology showed an intra-vascular hyaluronic acid embolus. The initial treatment approach was conservative, but the patient’s clinical state degraded. She was thus treated with sub-cutaneous hyaluronidase, the enzyme that degrades hyaluronic acid, which yielded a moderate improvement even though it was administered 22 days after the initial hyaluronic acid injection. Although hyaluronic acid embolism and subsequent cutaneous necrosis are well-known complications of dermal fillers, there are few reported cases of embolism following intra-articular injection. To our knowledge, this is the first time hyaluronidase has been used in this setting.

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Aaron, M., Qing Huang, Y., Bouffard, D., Costa, J. P., & Côté, B. (2021). A case of cutaneous necrosis due to intra-articular hyaluronic acid and treated with hyaluronidase. SAGE Open Medical Case Reports, 9. https://doi.org/10.1177/2050313X211025110

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