Bilateral Gram‐Negative Facial Abscesses After Polynucleotide Injections

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ABSTRACT Background Polynucleotide (PN) injections are increasingly used for facial rejuvenation, but severe infectious complications remain poorly characterized. Case Report We 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. Conclusion A 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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