Immunologic Research

, Volume 65, Issue 1, pp 285–292 | Cite as

Rapidly progressive diffuse systemic sclerosis after local vitamins A, D and E complex injections: literature review and report of two cases

  • Gustavo Guimarães Moreira Balbi
  • Ricardo Azêdo Montes
  • Verônica Silva Vilela
  • Marcella Azevedo Borges Andrade
  • Monisa Martins Nóbrega
  • Luna Azulay-Abulafia
  • Roberto Souto da Silva
  • Evandro Mendes Klumb
  • Roger Abramino Levy
Therapeutic Aspects in Autoimmunity


The term autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) or Shoenfeld’s syndrome refers to a wide group of immune-mediated diseases triggered by external agents. Several substances, such as vaccine adjuvants, squalene and silicone implants, are implied in the pathogenesis of ASIA syndrome. Treatment and prognosis of this complex condition are not completely known due to lack of good quality evidence. After a brief introductory literature review on ASIA, we report here two cases of patients that developed rapidly progressive systemic sclerosis clinical features after multiple intramuscular local injections of a substance recommended by a non-medical professional called ADE. ADE is an oily vitamin complex for veterinary use, and it was used in these cases for cosmetic muscular definition and enhancement purpose. To our knowledge, this is the first paper to describe the relation between injections of ADE and the development of ASIA with severe systemic sclerosis phenotype. Further investigation is needed to better understand the pathophysiology and to provide the basis for the treatment of this condition.


Systemic sclerosis Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) Shoenfeld’s syndrome ADE 



We would like to thank Drs. Maria de Fátima Guimarães Scotelaro Alves, Clarissa Canella Moraes do Carmo, Pedro Antônio Ramon Haddad, Tathiana Fernandes Mattos Bahia Alves, and Verônica de Brito Mello Maia for the contributions in the cases.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interests.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Gustavo Guimarães Moreira Balbi
    • 1
  • Ricardo Azêdo Montes
    • 1
  • Verônica Silva Vilela
    • 1
  • Marcella Azevedo Borges Andrade
    • 1
  • Monisa Martins Nóbrega
    • 2
  • Luna Azulay-Abulafia
    • 2
  • Roberto Souto da Silva
    • 2
  • Evandro Mendes Klumb
    • 1
  • Roger Abramino Levy
    • 1
  1. 1.Department of Rheumatology, Hospital Universitário Pedro ErnestoUniversidade do Estado do Rio de JaneiroRio de JaneiroBrazil
  2. 2.Department of Dermatology, Hospital Universitário Pedro ErnestoUniversidade do Estado do Rio de JaneiroRio de JaneiroBrazil

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