Case report of delayed hypersensitivity reactions to hyaluronic acid dermal filler agents following viral infection with the SARS-CoV-2 virus

Introduction: presentation of two case studies where documented SARS-CoV-2 infection preceded delayed-type hypersensitivity reactions to hyaluronic acid (HA) dermal filler agents. Case Presentation: two cases of delayed-onset hypersensitivity, with symptoms including pain and swelling, in sites of previously injected HA filler agents are described. Both of our patients had reported an active COVID-19 infection within 2-12 weeks of symptom onset. These adverse events are thought to be secondary to Type IV, cell mediated, hypersensitivity reactions in response to a viral illness. Management and Outcome: both patients were successfully treated with a 6-day course of methylprednisolone with complete resolution of swelling in the treated areas. Discussion: SARS-CoV-2 seems to cause similar delayed-hypersensitivity reactions to those previously seen in response to other influenza-type viruses and a similar management strategy with oral steroid taper appears to be effective. © Salus Internazionale ECM srl-Provider ECM no 763.