title: Systemic inflammatory disease resolution following cosmetic silicone breast implant removal.
abstract: A 37-year-old Caucasian woman presented with subacute, symmetrical inflammatory arthralgia, which was affecting her work. Apart from fatigue, she had no other constitutional symptoms. She had undergone cosmetic bilateral silicone breast implant surgery in 2008. Blood tests revealed erythrocyte sedimentation rate 53 mm/h, weakly positive antinuclear antibodies and IgG cardiolipin antibody, while breast ultrasound revealed a ruptured left silicone implant. The working diagnosis was systemic inflammatory disease of uncertain origin. She decided to have replacement, rather than removal, of her silicone breast implants privately, but her symptoms persisted postoperatively with a new erythema multiforme-like rash despite treatment with methotrexate and moderate dose prednisolone. Following further consultation with a National Health Service breast surgeon, her silicone implants were removed. Within 10 weeks of surgery, all immunomodulatory treatment was discontinued with complete symptom and inflammatory response resolution. This case illustrates that implant silicone can induce clinically significant systemic inflammatory disease and implant removal is essential for disease resolution.
authors.affiliation: Department of Dermatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK.
authors.forename: Sue Ann
authors.initials: SA
authors.lastname: Chan
authors.affiliation: Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK.
authors.forename: Feryal
authors.initials: F
authors.lastname: Malik
authors.affiliation: Department of Plastic Surgery, Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Wharton
authors.affiliation: Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK.
authors.forename: Rainer
authors.initials: R
authors.lastname: Klocke
mesh_terms: D000328:Adult; D018427:Breast Implants / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects; D011475:Prosthesis Failure / Q000009:adverse effects; D019919:Prosthesis Implantation / Q000379:methods; D012086:Reoperation; D020034:Silicone Gels / Q000009:adverse effects; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D020034:Silicone Gels