Hyaluronic acid
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Pulmonary emboli: case report A 57-year-old man developed pulmonary emboli after receiving hyaluronic acid [Supartz] injections for knee pain. The man was admitted with shortness of breath accompanied by sharp chest pain radiating to the right shoulder and back, and exacerbated by coughing and deep inspiration. He had a history of bilateral knee pain, with severe chrondromalacia noted during a meniscectomy. He had received one course of 5 weekly injections of 1% hyaluronic acid (2.5mL of Supartz) in the right knee a year before admission, and a second course of bilateral injections were finished a month before admission, interrupted after 4 out of 5 planned injections. At admission, radiological studies revealed extensive patchy bilateral ground-glass opacities. His symptoms spontaneously resolved within 48 hours, and he was discharged home. Three weeks later, regions of groundglass opacity were still clear on chest CT, but no bronchoscopy was conducted. At follow-up 3 months later, pulmonary function tests revealed an abnormal DLCO, and an open lung biopsy was performed. An amorphous substance was present in many medium and small pulmonary arteries, and was found on staining to contain hyaluronic acid and fibrin; a bone marrow embolus was also seen. A diagnosis of respiratory bronchiolitis and emphysema associated with mild bronchiolar fibrosis and focal peribronchial metaplasia was made. The man subsequently received a course of 4 intraarticular injections of hyaluronic acid without incident. Follow-up chest CT a year later revealed the ground-glass opacities had resolved. Repeat pulmonary function tests showed no change in the decreased DLCO. At 31 months, a chest x-ray was normal. Author comment: "In this report we present a case of pulmonary emboli consequent to a therapeutic injection of [hyaluronic acid]". Bhagat R, et al. Pulmonary emboli from therapeutic sodium hyaluronate. Respiratory Care 57: 1670-1673, No. 10, Oct 2012. Available from: URL: http:// 803080928 dx.doi.org/10.4187/respcare.01666 - USA
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Reactions 8 Dec 2012 No. 1431
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