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LETTER TO THE EDITOR
Year : 2017  |  Volume : 8  |  Issue : 5  |  Page : 373-374  

Localized lipodystrophy following single dose intramuscular gentamycin injection


1 Department of Paediatrics, VMMC & Safdarjung Hospital, New Delhi, India
2 Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication15-Sep-2017

Correspondence Address:
Indar K Sharawat
1534, Sector 11D, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_390_16

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How to cite this article:
Sharawat IK, Dawman L. Localized lipodystrophy following single dose intramuscular gentamycin injection. Indian Dermatol Online J 2017;8:373-4

How to cite this URL:
Sharawat IK, Dawman L. Localized lipodystrophy following single dose intramuscular gentamycin injection. Indian Dermatol Online J [serial online] 2017 [cited 2020 Apr 2];8:373-4. Available from: http://www.idoj.in/text.asp?2017/8/5/373/214723

Sir,

Lipodystrophy (also called lipoatrophy) is characterized by loss of subcutaneous fatty tissue. Lipodystrophy may be congenital or acquired; it can be partial or generalized. Acquired lipodystrophy is the most common form and is further classified into primary (idiopathic) or secondary types.[1] The localized form of acquired lipodystrophy can be due to steroid injection, insulin injection, penicillin injection, and other injections such as DPT vaccine among other medications.[2]

A 9-month-old male child came to us with the complaint of localized depression over the left gluteal region since 2 months. The depression was progressive for the initial 15 days followed by non-progression for the remaining period. Four months prior to the presentation, the child had cough, coryza, and fever for 5 days, and had received oral amoxicillin and single dose of intramuscular (IM) gentamycin over the left gluteal region by a local practitioner for upper respiratory symptoms. He did not receive any other IM injection over the same gluteal region. There was no history of excessive cry, tenderness, redness, and swelling. There was no history of acupuncture and recurrent pyogenic skin infections. After 2 months of IM injection, his mother noticed a slight asymmetry in the gluteal region, in the form of a depression over the left side, which was non progressive except for the initial 15 days. On examination, a depressed circular plaque, measuring 4.2 × 4.0 cm [Figure 1], was observed over the left upper and outer quadrant of gluteal region. The skin overlying the depression was normal. There was no redness, tenderness, or hyperkeratosis over the atrophied area. There was no sign of any chronic inflammation or vasculitic disease during clinical examination. The human immunodeficiency (HIV) test and antinuclear antibodies titres were negative. Skin biopsy was not done due to parental refusal. Parents were counselled regarding the nature of the atrophic scar and no treatment was given to the child.
Figure 1: A depressed circular plaque, measuring 4.2 × 4.0 cm over the left upper and outer quadrant of gluteal region

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Our patient had an IM injection over the gluteal region. Many case reports have been reported with regards to various medications including aminoglycosides (Amikacin), however, partial lipodystrophy secondary to injection gentamycin has not been reported in literature till now to the best of our knowledge. The etiology of lipodystrophy is believed to be either inflammatory or non-inflammatory. Hisamichi et al. described 2 cases with localized involutional lipoatrophy who had received IM steroid injections. Immuno-histochemical studies with the antibody against macrophages revealed that macrophages were scattered in the shrunken lipocytes in the subcutaneous tissues and around a well-vascularized and hyaline background.[3] Dahl et al. in their retrospective study of 16 patients with localized involutional lipoatrophy also showed that there was a progressive decrease in the individual fat cells size and number, which resulted in diminished fat lobules. Scattered macrophages were present within the fat lobules and surrounding connective tissues.[4] The diagnosis of the condition is mainly clinical, and skin biopsy is required to rule out any other associated conditions. We did not perform a histology examination as we had attributed it to post IM injection lipodystrophy. It is a common pattern of post-injury response to fat tissue, which is characterized by infiltration of fat lobules by macrophages.[5] No specific medical treatment exists, and it depends on the cause of lipodystrophy. Reassurance of the parents and patient is an important step. If the lesion persists and parents are concerned of the cosmetic implications, many cosmetic procedures such as fat transfer by flaps or grafts or implants and normal saline infiltration can be given as an option for improvement of the appearance.

Because buttock muscles are not well developed in infants and toddlers, this site should not be used for IM injections. Because of the related IM injection site complications, health care personnel should follow the basic rules and guidelines provided to minimize the complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Kuperman-Beade M, Laude TA. Partial lipoatrophy in a child. Pediatr Dermatol 2000;17:302-3.  Back to cited text no. 1
    
2.
Kumar V, Kumar M, Grover C. Localized lipoatrophy after intramuscular amikacin. Indian J Dermatol Venereol Leprol 2009;75:552.  Back to cited text no. 2
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3.
Hisamichi K, Suga Y, Hashimoto Y, Matsuba S, Mizoguchi M, Ogawa H. Two Japanese cases of localized involutional lipoatrophy. Int J Dermatol 2002;41:176-7.  Back to cited text no. 3
    
4.
Dahl PR, Zalla MJ, Winkelmann RK. Localized involutional lipoatrophy: A clinicopathologic study of 16 patients. J Am Acad Dermatol 1996;35:523-8.  Back to cited text no. 4
    
5.
Garg A. Acquired and inherited lipodystrophies. N Engl J Med. 2004;350:1220-34.  Back to cited text no. 5
    


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