Necrotic skin reaction following the administration of intramuscular injections of long-acting cabotegravir/rilpivirine and alternatively-sourced testosterone

In this case, we describe a 52-year-old man who was switched to long-acting cabotegravir/rilpivirine (CAB/RPV LA) injectable antiretroviral therapy (ART) on a background of well-controlled HIV. He subsequently developed a painful and swollen area on his right ventrogluteal region 10 days after his first CAB/RPV LA injections when he injected alternatively sourced testosterone in the same region. Examination findings showed a firm and defined lump with ecchymosis noted on the skin overlying. His initial blood results did not show any gross abnormalities and an ultrasound of the area was equivocal. After being reviewed in ambulatory care, the emergency department and an outpatient plastic surgery clinic settings over the course of 3 weeks, the swelling and skin changes gradually resolved. He was then switched back to oral ART on subsequent review.