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Delirium With Psychotic Features Possibly Associated With Mesotherapy

Key Words: Delirium • Mesotherapy

TO THE EDITOR: We would like to report a case of a delirium with psychotic features possibly associated with mesotherapy.

Case Report
The patient is a 40-year-old professional woman who travels for her work. While staying at a local luxury hotel, she suddenly awoke at 2:30 A.M., feeling terrified and convinced that her room was haunted. She telephoned the hotel reception desk screaming for an ambulance. She then put on her bathrobe and ran out into the corridor. Hotel security found her confused and rambling and brought her to the emergency department. At the emergency department, she was noted to be in a state of confusion and distress; she had rapid and pressured speech, and alternated between praying and trying to convince the staff around her to convert to her religious beliefs. She was given an intramuscular injection of haloperidol 5 mg, which did calm her down. When she was reviewed, 2–3 hours later, she was calm, fully oriented, logical, and sensible. She was able to recall the preceding events in great detail, and said she felt as though a spirit was inside her, controlling her thoughts, but those feelings were gone.

Earlier the previous day (estimated at 8–12 hours before the onset of delirium) she had undergone bilateral mesotherapy of both thighs. This was her first mesotherapy treatment. She felt well during and immediately after the injections. She had no past personal or family history of psychiatric disorders or substance abuse, no significant past medical, surgical, or travel history, so this was the first such episode for her. She was not on any hypnotic or other medications and denied alcohol use.

Extensive work-up, including brain imaging and a large panel of laboratory investigations, were all within normal limits. She was admitted to the psychiatry inpatient service. After 2 days of close observation but without any medications, she was discharged with no residual symptoms.

Discussion
Mesotherapy is a technique that involves microinjections into the mesoderm.¹ Intra- and subcutaneous injections are done with a variety of chemicals, but there are no standardized dosages or ingredients. The most common chemical used for treatment of localized fat deposits is phosphatidylcholine.² Other formulations may include carnitine, hyaluronidase, and other substances. Phosphatidylcholine is a phospholipid extracted from soybean lecithin and is found in cell membranes; it is involved in cell structure and transport. It can alter cholesterol and other triglyceride metabolism and appears to increase cholesterol solubility.³ The most common side effects of mesotherapy are localized bruising or edema; however, liver toxicity, demyelination of nerves, and atypical mycobacterial infections have been reported.⁴ In this patient, we did not know the contents of the injection. It is possible that the injected substance(s) crossed the blood–brain barrier and had direct affects on the brain substrate. From our literature search, we have not found any reports of psychiatric symptoms associated with mesotherapy; hence, we would like to report this case to highlight the need for more controlled studies on the safety of this procedure.

REFERENCES

1. Vedamurthy M: Mesotherapy. Indian J Dermatol Venereol Leprol 2007; 73:60–62[Medline]
2. Rotunda AM, Kolodney MS: Mesotherapy and phosphatidylcholine injections: historical clarification and review. Dermatol Surg 2006; 32:465–480[CrossRef][Medline]
3. Hexsel D, Serra M, Mazzuco R, et al: Phosphatidylcholine in the treatment of localized fat. J Drugs Dermatol 2003; 2:511–518[Medline]
4. Nagore E, Ramos P, Botella Estrada R, et al: Cutaneous infection with Mycobacterium fortuitum after localized microinjections (mesotherapy) treated successfully with a triple drug regime. Acta Derm Venereol 2001; 81:291–293[CrossRef][Medline]

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Tor, P.-C. Articles by Lee, T.-S. Search for Related Content PubMed Citation Articles by Tor, P.-C. Articles by Lee, T.-S. Delirium Schizophrenia Spectrum Disorders

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