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.”

2 thoughts on “Case Report: Loss of leg fat through bad injection technique”

  1. Interesting. Is this IFN-B specific? Did the patient consistently inject in this specific spot? As an eight year Copaxone user I have endured literally thousands of injections. Although I have heard other Copaxone users complain of lipotrophy, my skin does not show any problems. I am religious about rotating my injection sites, prefer to inject onto warm clean skin, and when blood is not drawn lightly rub over the skin to encourage dispersal. Copaxone instructions specify injection at right angles. Are there differences between injection instructions and policies between the DMD's- should these be reviewed? It is interesting to read patient user boards – even with Copaxone, there are many different methods used, seemingly indicating variances between Copaxone nursing staff who cover the drug service lines. Different countries seem to have different practices. Is this a problem preculiar to IFN-B?

  2. Yeah, that is if the NHS and PCTs pay for these 'emerging oral treatments'.I am shocked to see that some British PCTs are now going bankrupt. How on earth can the NHS let such things happen. Money problems are going to ruin the chances of British MSers getting hold of emerging drugs. That's not fair!

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