Infectious intracranial aneurysm caused by infective endocarditis following buccal fat pad removal - An esthetic plastic procedure.

Background: The demand for cosmetic treatments in Japan is increasing, especially among young adults, yet rare but serious infectious complications related to esthetic plastic surgery (APS) remain underrecognized. To address this gap, we report a case of an infectious intracranial aneurysm (IIA) caused by infective endocarditis (IE) following buccal fat pad (BFP) removal, a type of APS.

Case description: A 25-year-old woman presented with fever and impaired consciousness. The patient had previously undergone BFP removal through an intraoral incision for cosmetic purposes 8 weeks ago. Transthoracic ultrasonography revealed vegetation (>17 mm) on the anterior mitral leaflet with mitral regurgitation, confirmed by transesophageal echocardiography. Blood cultures identified Abiotrophia defectiva, a common oral flora. Computed tomography angiography revealed a newly developed, unruptured IIA in the right middle cerebral artery (7 × 5 mm). The patient was transferred to our hospital for mitral valve repair. To minimize the risk of aneurysm rupture during surgery using cardiopulmonary bypass, we first performed coil embolization followed by mitral valve repair. The patient recovered without neurological deficits.

Conclusion: This case highlights a previously unrecognized but important clinical issue: IIA caused by IE can occur after APS. Neurosurgeons and esthetic plastic surgeons should be aware that infectious aneurysms represent a significant potential complication of APS.