A case of diffuse alveolar hemorrhage associated with hyaluronic acid dermal fillers

Patient: Male, 25 Final Diagnosis: Diffuse alveolar hemorrhage Symptoms: Cough dry • short of breath Medication: — Clinical Procedure: — Specialty: — OBJECTIVE: Unusual clinical course BACKGROUND: Hyaluronic acid is a substance that is naturally present in the human body, especially in joints and eyes. Hyaluronic acid injectable gels have been available for the general market since 2003 as cosmetic dermal fillers and skin boosters. Diffuse alveolar hemorrhage is an acute event that threatens the life of the patient and can lead to pulmonary fibrosis. Alveolar hemorrhage associated with hyaluronic acid dermal fillers is an entity that to the best of our knowledge has never been described in the medical literature. CASE REPORT: We describe a patient who presented with dyspnea and cough after a subcutaneous injection of hyaluronic acid, with radiographic abnormalities including ground glass opacities and consolidation. The patient underwent flexible bronchoscopy and was diagnosed with diffuse alveolar hemorrhage. CONCLUSIONS: This case emphasizes that this life threatening condition may occur with the use of this medication and physicians must be aware of this disorder, as early recognition and management can reduce morbidity.