A 20-year-old woman with rapidly progressive dyspnea and diffuse pulmonary infiltrates

Abstract

Silicone is a liquid polymer previously considered to be immunologically inert and favored in cosmetic procedures. Increasing evidence shows a multisystemic inflammatory reaction to its administration constituting the silicone embolism syndrome (SES). The majority of adverse effects are seen in the pulmonary system resulting in extensive diffuse alveolar damage and ultimately ARDS. Neurologic involvement occurs frequently and is uniformly fatal. Large volume injections, high pressure infiltrations and prior exposure to silicone have been implicated, with an IgG polydimethylsiloxane antibody described. Most patients meet Schonfield criteria for fat embolism syndrome and treatment is largely supportive. As the illicit use of injectable silicone rises worldwide, so does the incidence of related morbidities and fatalities, necessitating a high index of suspicion for SES in patients with neurologic or pulmonary symptoms and recent exposure to liquid silicone. We report an unusual case of multi-organ dysfunction following silicone injection.