Injection site reaction induced by liraglutide use in a female patient with obesity

INTRODUCTION: Glucagon-like peptide-1 agonists (GLP-1 agonists) are one of the top treatment options in obesity and/or type 2 diabetes (T2D) according to the guidelines. It is well tolerated in patients with cardiovascular disease or chronic kidney disease. Allergic symptoms such as rash and pruritus have been reported in some publications in the use of liraglutide. We also reported an allergic reaction in the injection site associated with liraglutide administration. CLINICAL CASE: A 38-year-old female patient was referred with the complaints of obesity and postprandial tremor and dizziness. She gained weight about 8 kg (from 81 kg to 89 kg) in the last year. She had been taking escitalopram and trazodone with a diagnosis of anxiety. She had no history of previous surgery, smoking or alcohol use. Family history had type 1 diabetes in her sibling and prediabetes in her mother. On physical examination, height was 175 cm, body weight 92 kilogram, BMI was 30 kg/m2, blood pressure 126/88 mmHg, and heart rate 90/min. Systemic examinations were unremarkable. Abdominal sonography revealed grade 1 hepatic steatosis. Glucose level was measured as 101 mg/dL, Hb A1C 6.1%, TSH 4.55 µIU/mL, free T4 0.88 ng/dL, LDL 142 mg/dL, total cholesterol 215 mg/dL. Glucose measurements after oral glucose load were in normal range. Levothyroxine 25 µg and liraglutide were prescribed. One month later, the patient lost weight about 4 kilograms, but a macular rash 2 cm in diameter around the umbilicus was detected on examination, consistent with an allergic reaction (Figure 1). The patient was prescribed desloratadine, and advised to continue the injections and called for close follow-up. In the follow-up, patient lost a total of 12 kg weight in 4 months, and the rash regressed and did not recur. [Figure: see text] CONCLUSION: In our case, a minor allergic reaction was observed with liraglutide use, and we continued liraglutide injection. We suggest close follow-up, continuation of liraglutide and addition of antihistaminics in the development of minor allergic reactions, considering the benefits and harms on a case-by-case basis.