Case Report: Loss of leg fat through bad injection technique

EpubWeise et al. Lobular panniculitis and lipoatrophy of the thighs with interferon-ß1a for intramuscular injection in a patient with multiple sclerosis. J Clin Neurosci. 2012 Jun 19.

Background: MSers may experience severe local inflammatory skin reactions during disease-modifying therapy with subcutaneously injected interferon-β (IFN-β). It is common clinical practice to switch those patients to an intramuscularly administered formulation, where severe local skin reactions have not been described. 

Case report: This is a case report of a 42-year-old woman with stable relapsing-remitting MS, who was switched from subcutaneously to intramuscularly injected IFN-β1a due to abdominal skin necroses and slight multifocal lipoatrophy (loss of fatty tissue under the skin). After two years of complication-free therapy with intramuscular IFN-β1a, the MSer slowly developed painful lobular panniculitis (inflamed nodules of fat under the skin) and severe lipoatrophy of both lateral thighs. A careful diagnostic workup identified misguided subcutaneous injections due to a wrong injection angle as the most plausible cause. Upon correction of her injection technique, pain and skin reddening resolved, while her disfiguring lipoatrophy was irreversible. 

Severe lipoatrophy post interferon-beta injection
Severe skin necrosis post interferon-beta injection
Conclusion: This report should enhance awareness that severe skin adverse effects may also occur, although rarely, with IFN-β for intramuscular injection. Early recognition and correction of the injection technique may help to prevent severe complications.

"Fortunately these severe skin (ulcers or necrosis) and subcutaneous (lipoatrophy) complications of interferon-beta injections are seldom seen these days. Improved injection technique, smaller needles and better education have made complications very rare. Nevertheless minor reactions are still a problem and MSers don't like them. Hopefully the emergence of oral treatments will allow MSers to switch to better tolerated drugs."

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