Sterile abscesses during GnRH agonist therapy for central precocious puberty: a case series and literature review.

Objectives: Long-acting gonadotropin-releasing hormone agonists (GnRHa) are standard therapy for central precocious puberty (CPP). Depot formulations (triptorelin, leuprolide) ensure sustained release via biodegradable matrices. Rare sterile injection-site abscesses may impair drug absorption and efficacy, and evidence on management is limited.

Cases presentation: Two patients (0.68 %) out of the 290 treated at our center with depot GnRHa between 2023 and 2025 developed recurrent culture-negative abscesses. They had normal immune workup and no IgE-mediated hypersensitivity or mastocytosis. Lesions caused pain, transient inflammation, and reduced efficacy. In one case, topical hydrocortisone butyrate 0.1 % for 5 days post-injection resolved abscesses and restored efficacy.

Conclusions: Sterile abscesses are a rare but relevant complication of GnRHa therapy. Early recognition and exclusion of infection/allergy are key. Our experience with a patient who showed a good response to topical corticosteroids may be relevant in offering a conservative therapeutic option to treat the abscess lesion without discontinuing GnRHa therapy.