The abuse potential would be that I think it opens the door to more easily create convincing doctored screenshots of comments and interactions. It's technically possible already, but I don't think we've really seen it on lemmy yet. There's ways around that, like formatting replaced text differently or marking those comments with a clear icon to indicate a regex replacement was used on them, but I still don't particularly like the idea.
I'm thinking that it would also make it easy for people to have confusing interactions, if somehow a regex ends up changing the meaning of a statement or something, and the user forgets they have it set up. I guess the "big icon indicating regex was applied" idea would work there too though. Maybe the icon could even be a button to toggle it on/off per comment?
The common use case I see for regex features on social media apps and addons is for hiding entire comments that match one of your patterns, and I generally think that's the best choice for implementation.
That said, with a clear indicator it had been applied it probably wouldn't be awful.