Painful muscle fibrosis following synthol injections in a bodybuilder: a case report

Abstract

Introduction: Synthol is a site enhancement oil used by bodybuilders to boost the cosmetic appearance of muscles. Here, we describe the case of a patient with severe side effects following repeated intramuscular injections of synthol in his right biceps muscle.

Case presentation: A 29-year-old Middle Eastern male bodybuilder, following intramuscular injections of synthol five years ago, presented with painful pressure in his right upper arm. On presentation to our clinic, his muscle appeared disfigured. Magnetic resonance imaging revealed scattered cystic fatty lesions in the muscle. The affected part was surgically removed and histopathology showed inflammatory changes with fibrosis and a so-called Swiss cheese pattern.

Conclusion: Synthol injections that are used for the short-term enhancement of muscle appearance by bodybuilders bear the danger of long-term painful muscle fibrosis and disfigurement.

Figure 1

Preoperative appearance of left biceps muscle. Right hand not shown due to distinguishing features.

Figure 2

Magnetic resonance image of swollen biceps muscle after intramuscular injection of synthol in (A) coronal T1-weighted turbo spin echo sequence and (B) transverse T2-weighted turbo spin echo sequence. Due to the presence of fat in the injected suspension, the total muscle had a hyperintense signal in T1-weighted and T2-weighted images compared with the surrounding healthy muscles. Several cystic lesions are scattered within the muscle with a hyperintense signal. These lesions are oil deposits between the muscle bundles.

Figure 3

Gadolinium-enhanced transverse T1-spin echo magnetic resonance image sequence with fat saturation of the right arm. The inhomogeneous contrast enhancement of the biceps muscle indicates the presence of inflammation.

Figure 4

The overview shows the destroyed muscular architecture and replacement of the muscle by connective tissue. ( A) Residual muscle fibers (asterisks) show pronounced myopathic changes while the connective tissue contains vacuoles with inflammatory infiltrates (arrows). Hematoxylin and eosin stain , ×10 magnification. ( B) Higher magnification reveals inflammatory infiltrates in the connective tissue and surrounding the vacuoles. Hematoxylin and eosin stain, ×40 magnification. ( C) Elastica van Gieson stain shows remaining muscle fibers (asterisks) with intermingled connective tissue and vacuoles, ×20 magnification. ( D) Multinucleated giant cells (arrows) and mononuclear infiltrates (arrowhead, cells negative for CD68) surround vacuoles, ×40 magnification.