Multisystem organ failure after large volume injection of castor oil

Silas W. Smith, Nathan M. Graber, Rudolph C. Johnson, John R. Barr, Robert S. Hoffman, Lewis S. Nelson

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

We report a case of multisystem organ failure after large volume subcutaneous injection of castor oil for cosmetic enhancement. An unlicensed practitioner injected 500 mL of castor oil bilaterally to the hips and buttocks of a 28-year-old male to female transsexual. Immediate local pain and erythema were followed by abdominal and chest pain, emesis, headache, hematuria, jaundice, and tinnitus. She presented to an emergency department 12 hours postinjection. Persistently hemolyzed blood samples complicated preliminary laboratory analysis. She rapidly deteriorated despite treatment and developed fever, tachycardia, hemolysis, thrombocytopenia, hepatitis, respiratory distress, and anuric renal failure. An infectious diseases evaluation was negative. After intensive supportive care, including mechanical ventilation and hemodialysis, she was discharged 11 days later, requiring dialysis for an additional 1.5 months. Castor oil absorption was inferred from recovery of the Ricinus communis biomarker, ricinine, in the patient's urine (41 ng/mL). Clinicians should anticipate multiple complications after unapproved methods of cosmetic enhancement.

Original languageEnglish
Pages (from-to)12-14
Number of pages3
JournalAnnals of Plastic Surgery
Volume62
Issue number1
DOIs
StatePublished - Jan 2009
Externally publishedYes

Keywords

  • Castor oil
  • Injection
  • Multisystem organ failure
  • Ricinine
  • Transgendered

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