TY - JOUR
T1 - Multisystem organ failure after large volume injection of castor oil
AU - Smith, Silas W.
AU - Graber, Nathan M.
AU - Johnson, Rudolph C.
AU - Barr, John R.
AU - Hoffman, Robert S.
AU - Nelson, Lewis S.
PY - 2009/1
Y1 - 2009/1
N2 - 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.
AB - 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.
KW - Castor oil
KW - Injection
KW - Multisystem organ failure
KW - Ricinine
KW - Transgendered
UR - http://www.scopus.com/inward/record.url?scp=65949089835&partnerID=8YFLogxK
U2 - 10.1097/SAP.0b013e31817763bd
DO - 10.1097/SAP.0b013e31817763bd
M3 - Article
C2 - 19131711
AN - SCOPUS:65949089835
SN - 0148-7043
VL - 62
SP - 12
EP - 14
JO - Annals of Plastic Surgery
JF - Annals of Plastic Surgery
IS - 1
ER -