Bilateral Gram-Negative Facial Abscesses After Polynucleotide Injections

BACKGROUNDPolynucleotide (PN) injections are increasingly used for facial rejuvenation, but severe infectious complications remain poorly characterized.

CASE REPORTWe report an otherwise healthy 57-year-old woman who developed progressive bilateral cheek inflammation after facial PN injections. Initial features resembled expected post-injection swelling, but worsening pain, fluctuance, rising inflammatory markers, and ultrasound-confirmed collections prompted aspiration and incision and drainage. Microscopy demonstrated gram-negative bacilli, and operative cultures grew Enterobacter cloacae complex and Klebsiella variicola. The patient improved after source control and targeted antimicrobial therapy, but 6-month follow-up showed residual post-drainage atrophic cheek scarring, including a right-sided soft-tissue contour depression.

CONCLUSIONA targeted literature search did not identify a prior published culture-confirmed gram-negative abscess after PN injection. This case highlights the need for early imaging, aspiration for culture, and consideration of gram-negative pathogens when post-cosmetic-injection inflammation is progressive, fluctuant, or not responding to usual gram-positive cover.

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