Delayed hypersensitivity reaction to hyaluronic acid dermal filler post-COVID-19 viral infection

Dermal fillers have been an effective therapy for people pursuing
noninvasive facial rejuvenation.1

Hyaluronic acid (HA) soft tissue fill-
ers specifically have become a popular device for an enhancement of

facial features over the last few years.2
We are presenting a case of a 32-year-old woman treated at The
Esthetic Clinics, Mumbai, in February 2020 for facial rejuvenation.
She was rejuvenated using dermal fillers at multiple sites on her face.
The patient is a regular patient with us and had facial rejuvenation

with dermal fillers regularly for the past 6 years and has never re-
ported any reactions or adverse effects related to dermal fillers in

the past (Figure 1A,B).
With her last dermal filler sitting in February 2020, the patient
was symptomless for months and experienced a sudden swelling in
the periocular area in December 2020. This area has received dermal
filler injections before. This was the first time the patient noted a
reaction to the fillers and surprisingly at a time when no procedures
had been performed for ten months. A thorough medical history
revealed a history of COVID-19 infection in November 2020, and
the patient was antigen positive and subsequently became antibody

positive as well. The swelling subsided in a few days after oral anti-
inflammatory treatment.

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