CLINICAL VIGNETTE |
Bodybuilding, sesame oil and vasculitis
Correspondence to: M. Koopman. E-mail: miriamkoopman{at}hotmail.com
A 21-yr-old bodybuilder was admitted to our hospital with a severe case of myalgia and purpura. Onset was 1 week after intramuscular self-injections of 10 ml sesame oil in both biceps. He had used sesame oil on five previous occasions. On physical examination approximately 10 blue, itchy lesions with a maximum size of 36 cm2 on the shoulders, arms and legs were discovered (Figure, lower panel) (The figure may be viewed in colour as supplementary data at Rheumatology Online.) The lesions failed to blanch on applying pressure. Magnetic resonance imaging of the affected muscles showed extensive oedema, suggesting local necrosis. Pathological examination of a skin–muscle biopsy of affected skin revealed a severe panvasculitis with mixed inflammatory cell infiltrate, composed of predominantly eosinophils, some lymphocytes and neutrophils (Figure, upper panel).
In this case it is very likely that the sesame oil injections caused an allergic reaction leading to vasculitis. The patient was treated with oral corticosteroids for 2 weeks and high-dose morphine injections in order to control his pain. After 4 weeks, recovery was complete.
Sesame oil is frequently used as a solvent, for example in intramuscular gold injections for rheumatoid arthritis. Moreover, it seems to be commonly used by bodybuilders [1]. In general, people should be more aware of possible allergic reactions to solvents like myalgia and vasculitis when using intramuscular drugs.
There is no conflict of interest or source of funding.
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References
- Darsow U, Bruckbauer H, Worret W-I, Hofmann H, Ring J. Subcutaneous oleomas induced by self-injection of sesame seed oil for muscle augmentation. J Am Acad Dermatol 2000;42:292–4.[Medline]
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