Description of Event or Problem · 1
(B)(6) IS A (B)(6) WHITE FEMALE THAT HAS HAD HYDRELLE PRIOR TO THIS ADVERSE REACTION ON (B)(6) 2010 IN LIPS AND INFRAORBITAL AREA WITH NO UNTOWARD EFFECT AT THAT TIME. IN RETROSPECT SHE CALLED THE OFFICE (B)(6) 2010 COMPLAINING THAT HER LIPS FELT WARM. SHE WAS TOLD THIS SHOULD SUBSIDE IN A FEW DAYS AND DID. SHE HAS NO SIGNIFICANT MEDICAL HISTORY OR ALLERGIES. ON (B)(6) 2010 HYDRELLE WAS PLACED IN HER LIPS AND A SMALL AMOUNT PLACED IN THE TEAR THROUGH DEFORMITY AREA BILATERALLY AS WELL AS SOME VISIBLE INDENTATIONS IN THE INFRAORBITAL AREA. (B)(6) CALLED THE OFFICE ABOUT 4 DAYS LATER COMPLAINING OF SOME SORENESS AND SWELLING WHICH SUBSIDED OVER THE NEXT FEW DAYS. ON (B)(6) 2011, SHE COMPLAINED OF SWELLING OF THE LIP WITH TENDERNESS AND NOTED SOME WHITE SPOTS ON LIP WITH ONE AREA THAT LEAKED PUS PRIOR TO HER OFFICE VISIT. SHE WAS SEEN IN THE OFFICE WITH VERY SWOLLEN UPPER LIP WITH OBVIOUS ABSCESS FORMATION IN SEVERAL AREAS OF UPPER LIP. THIS WAS I&D WITH 18G NEEDLE WITH REMOVAL OF YELLOW PUS WITH SOME SEROSANGUINOUS STREAKING. CULTURE WAS DONE AND SHOWED NO GROWTH. HYALURONIDASE 30 UNITS DILUTED WITH NORMAL SALINE WAS PLACED IN UPPER LIP AND RIGHT CORNER OF UPPER LIP. LOWER LIP WAS SLIGHTLY TENDER. SHE WAS PLACED ON KEFLEX, LORTAB FOR PAIN AND ORAL STEROID (METHYLPREDNISOLONE) DOSE PACK. ON (B)(6) 2011, SHE WAS AGAIN SEEN WITH DECREASE IN SWELLING WITH GOOD IMPROVEMENT AND AGAIN A SMALL AMOUNT OF HYALURONIDASE 75 UNITS WAS INJECTED WITH HYALURONIDASE WITH 30 UNITS. ON (B)(6) 2011 OFFICE VISIT, SHE WAS DOING BETTER WITH DECREASED SWELLING AND TENDERNESS, BUT STILL HAD AREAS ON UPPER AND LOWER LIP THAT WERE HARD, ESPECIALLY ON THE VERMILLION BORDER OF UPPER LIP. SHE WAS STILL ON METHYLPREDNISOLONE 8MG BID. SIXTY UNITS HYALURONIDASE WAS DILATED AND INJECTED INTO LOWER LIP. SHE WAS ALSO PLACED PROPHYLACTICALLY WITH VALTREX 1GM Q.D X 1 WEEK. ON (B)(6) 2011, SHE COMPLAINED OF TENDERNESS UNDER RIGHT EYE WITH A NODULE FORMING APPROXIMATELY 0.6MM DIAM. LOWER LIP AGAIN SHOWED SOME PUS ACCUMULATION AND WAS I&D AND DRAINED. SHE ALSO DEVELOPED AN AREA OF ERYTHEMA TO CHIN THAT APPEARED TO BE CELLULITIS. AGAIN HYALURONIDASE 15 UNITS INJECTED TO LOWER LIP ALONG WITH KENALOG-5, 06CC. ZITHROMAX WAS PRESCRIBED FOR CELLULITIS OF MENTALIS AREA. ON (B)(6) 2011 I&D OF AREA UNDER RIGHT INFRAORBITAL AREA REMOVED A SMALL AMOUNT OF PUS SIMILAR TO WHAT WAS DONE EARLIER. KENOLOG - 5 AND HYALURONIDASE WAS PLACED UNDER BOTH INFRAORBITAL AREAS THAT WERE INJECTED WITH HYDRELLE. RECHECK ON (B)(6) 2011 SHOWED ALL AREAS TO BE STABLE AND IMPROVING. SHE WAS INSTRUCTED AND GIVEN MY PERSONAL NUMBER TO CALL IF THERE WERE ANY CHANGES AT ALL. HER FOLLOW UP APPOINTMENT IS IN 2 WEEKS.