Deterioration of autoimmune condition associated with repeated injection of dextranomer/hyaluronic acid copolymer: A case report

Abstract A 6-year-old girl underwent ureterocystoneostomy (UCN) because of left flankpain due to delayed onset of ureteral stenosisone and a half years after endoscopic dextranomer/ hyaluronic acidcopolymer (Deflux) injection for the treatment of vesicoureteral reflux(VUR). Histopathological examination indicated chronic inflammation with abundant eosinophils characteristic of a reaction to Deflux. Several autoimmune diseases developed during the treatment for ureteral stenosis. First, 2 weeks prior to the onset of left flankpain, she was diagnosed as having systemic lupus erythematosus. Finally, she died of pulmonary hemorrhagedue to thrombotic thrombocytopenic purpura4 months after UCN. The fatal outcome in this case was suspected to be caused by autoimmune syndrome induced by adjuvants, which in this case was the hyaluronic acidpolymer injected into the ureteric orificefor the treatment of VUR.