Late-onset gluteal Escherichia coli abscess formation 7 years after soft tissue augmentation with Bio-Alcamid in a HIV-positive patient

In 2002, a 41-year-old woman had been treated for severe buttock lipodystrophy resulting from highly active anti-retroviral (HAART) therapy medication. During a single session the loss of subcutaneous fatty tissue had been compensated by injections of an undefined quantity of polyalkylimide 4% (Bio-Alcamid™, Polymekon Biotech Industry, Milan, Italy). The post-treatment course had been uneventful and the patient had initially been satisfied with the result of this treatment. Seven years later, the patient presented with a redness and swelling of the area (Figure 1) by our unit. The area was hard and extremely painful on touch. All previous antibiotic therapies led only to temporary relief of these symptoms. A bedside drainage of the abscess was performed through a 20-gauge intravenous cannula that was inserted in the thin collagen capsule surrounding the gel (Figure 2). The patient underwent bedside irrigations with 10% povidone-iodine solution three times daily. Large spectrum antibiotics were continued intravenously. Microbiologic culture demonstrated the growth of Escherichia coli susceptible to the first line antibiotic treatment Levofluoxacina (intravenous Levoxacin®, a vial/24 h for three days). The inflammation subsided, and the infection had resolved 3 days after admission. The patient was discharged from our department with a 7-day regimen of oral Levoxacin® (500 mg/24 h). Re-examination of the patient after 1, 3, 10 and 18 weeks yielded no signs of granuloma formation or local findings of inflammation or irritation. No further treatment was required.