Bone Miner. 1993 Jul;22(1):33-41. Related Articles, Links


'Mucoid dissolution' of bones and multiple pathologic fractures in a patient with past history of intravenous administration of polyvinylpyrrolidone (PVP). A case report.

Kepes JJ, Chen WY, Jim YF.

Department of Pathology and Oncology, University of Kansas School of Medicine, Kansas City 66103.

Polyvinylpyrrolidone (PVP) has been used in industry as well as in medicine for various purposes, e.g. as a component of hair-sprays, 'retardant' for subcutaneous injections, and given intravenously as a plasma expander. The latter usage results in deposition of PVP in the reticulo-endothelial system and other mesenchymal cells, including osteocytes. A middle aged woman in Taiwan, who for 10 years received repeated intravenous injections of PVP, suffered pathologic fractures of both femora and her right humerus with additional destructive lesions seen radiologically in other bones. Biopsies of the fracture sites showed both intracellular PVP deposits and mucoid changes in the involved cells, a characteristic secondary complication of PVP deposition. This phenomenon, if of sufficient severity, may cause, as in this case, a virtual 'melting down' of osseous tissue with pathological fractures as a consequence.

Publication Types:
Case Reports



Z Hautkr. 1984 Aug 1;59(15):1027-37. Related Articles, Links
[Clinical variability of polyvinylpyrrolidone dermatosis]
[Article in German]
Mensing H, Koster W, Schaeg G, Nasemann T.

Several pharmaceutics on the market contain polyvinylpyrrolidone (PVP). As the high-polymeric parts of the PVP molecules cannot be eliminated after parenteral or subcutaneous application, they accumulate in the organism. PVP residues in the dermis cause a considerable variability of skin changes, ranging from deposits nearly without reactions up to swelling, papules, granulomas and pseudotumors.

Publication Types:
Case Reports

PMID: 6485450 [PubMed - indexed for MEDLINE]



Am J Surg Pathol. 1997 Nov;21(11):1361-7. Related Articles, Links

Cutaneous involvement in polyvinylpyrrolidone storage disease: a clinicopathologic study of five patients, including two patients with severe anemia.
Kuo TT, Hu S, Huang CL, Chan HL, Chang MJ, Dunn P, Chen YJ.
Department of Pathology, Chang Gung University and Chang Gung Memorial Hospital, Kwei San, Tao Yuan, Taiwan.

Polyvinylpyrrolidone (PVP), formerly a plasma expander, has continued to be inappropriately used in Taiwan for intravenous injection as a "blood tonic." Five cases of PVP storage disease with cutaneous involvement were studied. Two patients presented with cutaneous eruptions mimicking collagen vascular disease and chronic pigmented purpuric dermatosis. Two other cases were found incidentally: one was with a metastatic tumor and the other in a pemphigus lesion. The fifth case was seen in a blind skin biopsy specimen taken to exclude Niemann-Pick disease after hematologic examination of a bone marrow smear. The latter patient and the patient with a collagen vascularlike disease also had severe anemia and serious orthopedic and neurologic complications due to massive infiltration of PVP-containing cells in the bone marrow with destruction of the bone. Severe irreversible anemia due to PVP storage disease has not been reported before. Three patients admitted having a history of receiving intravenous injection of PVP. The samples obtained from two of them indeed contained 5% PVP as determined by chemical analysis. PVP storage disease can be diagnosed by its histopathologic features. The skin biopsy specimens all showed a variable number of characteristic blue-gray vacuolated cells around blood vessels and adnexal structures with positive tinctorial reactions to mucicarmine, colloidal iron, and alkaline Congo red and negative to periodic acid-Schiff (PAS) and alcian blue. The PVP storage cells were shown to be CD68+ macrophages. The presence of PVP in the skin induced little or no inflammatory reaction. Only the pelvic mass in one patient had a foreign body granuloma formation. Our study showed that systemic parenteral administration of PVP preparation could result in the accumulation of PVP storage cells in the skin, with or without clinical eruptions. The diagnosis of systemic PVP storage disease can be established by performing a skin biopsy for pathologic study. It is important for pathologists and clinicians to be aware of this iatrogenic storage disease to avoid misdiagnosis for hereditary storage disease, osteomyelitis, or signet-ring cell carcinoma. Serious hematologic and orthopedic complications can be caused by repeated massive intravenous injection of PVP. Therefore, PVP preparations should be strictly prohibited for systemic administration.

PMID: 9351574 [PubMed - indexed for MEDLINE]


Hautarzt. 1983 Nov;34(11):555-60. Related Articles, Links



[Iatrogenic pseudotumor of the skin induced by polyvinyl pyrrolidone]

[Article in German]

Oehlschlaegel G, Marquart KH, Steuer G, Burg G.

A 65-year-old woman developed a prominent tumor-like swelling of the skin in the face and shoulder area after having received parenteral applications of a drug containing polyvinylpyrrolidone (PVP) (Depot-Impletol) for many years. Upon first examination the alterations appeared to represent a tumor of the adipose tissue. Subsequently, however, they were shown to result from excessive storage of high-molecular fractions of PVP in the reticulohistiocytic system. Storage of these fractions of PVP, which cannot be eliminated with urine, was also found in the interstitial tissue of adjacent muscles and in local lymph nodes. The histological picture resembles a thesaurismosis. The present report also describes enzyme histochemical and electron-microscopic findings. The electron-microscopic results are similar to those described by other authors in the few ultrastructural reports of PVP storage. The ultrastructural alterations in the capillary endothelium suggest a transendothelial transport mechanism for the incorporated substance.

Publication Types:
Case Reports


Arkh Patol. 1992;54(11):21-7. Related Articles, Links


[Tissue reactions in children treated with hemodynamic dextran and detoxication polyvinylpyrrolidone plasma substitutes]

[Article in Russian]

Cherstvoi ED, Nikoforov IuE, Vlasov LE, Nerovnia AM.

By means of light and electron microscopy tissue reactions produced by repeated use of polyvinylpyrrolidone (PVP) and dextran plasma substitutes are studied on the material of 20 autopsies and 4 biopsies as well as in 65 experimental cases. Delayed type of PVP accumulation in tissues after the hemodes administration is determined as well as its dependence on the dose, time, kidney function and the presence of inflammatory foci. The differences in tissue reactions after administration of dextran and PVP substitutes are established. The results indicate that medicinal thesaurismosis may develop only after repeated infusions of PVP substitutes, while dextran accumulation is of a transitory type and results in characteristic morphological changes in the renal epithelium only.

PMID: 1283299 [PubMed - indexed for MEDLINE]

Arkh Patol. 1984;46(10):64-71. Related Articles, Links


[Clinico-morphological characteristics of the sequelae of the parenteral administration of gemodes and polyglucin to children]

[Article in Russian]

Samokhin PA, Romanenko VA.

In 38 dead children and in a resected lung of an operated child, the alterations were discovered, connected with accumulation in tissues of hemodez and polyglucin after their parenteral administration. The same picture of the so-called iatrogenic thesaurosis was reproduced in 16 rabbits that received the above preparations intravenously. Three degrees of accumulation were distinguished which directly depended on the dose and time of synthetic plasma substituents administration, both on clinical and experimental material. It is recommended to take into consideration the alterations revealed in this study in the diagnosis of some enzymo- and lymphadenopaties, giant-cell vasculitis, and granulomatous processes. The secondary immunodeficiency is suggested in children with iatrogenic thesaurosis, on the basis of the disease histories and morphological data.

Publication Types:
Case Reports

PMID: 6210071 [PubMed - indexed for MEDLINE]

Zentralbl Allg Pathol. 1984;129(2):105-10. Related Articles, Links


[Morphological findings in lymph nodes, spleen and liver in the rat following treatment with polyvinylpyrrolidone and trypan blue (light microscopy studies)]

[Article in German]

Nakopoulou L, Tseleni-Balafouta S, Zinozi M, Papacharalampous NX.

Lymph nodes, spleen and liver from 36 rats were studied by light microscope following prolonged administration of PVP and TB. When PVP had been administrated, the invasion of all the organs by large foam cells of RES was apparent while the structure of the organs had been destroyed. The animals which had received PVP combined with TB had less reticuloendotheliosis of the organs while their structure was maintained to a greater extent. The latter animals also had greater cellular reaction. All the rats showed obvious cachexia which was more apparent in those having received only PVP.

PMID: 6730747 [PubMed - indexed for MEDLINE]