SESSION TITLE: Diffuse Lung Disease 1 SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/07/2018 03:30 pm - 04:30 pm INTRODUCTION: Interstitial Lung Disease can be associated with a broad range of diseases, exposures, drugs, and can be idiopathic. Silicosis has been understood as a cause of pulmonary disease for centuries. Silicosis inhalation is seen by occupational exposure such as sandblasting, mining, and masonry. Injected silicone is a liquid form of silicone and is commonly used in plastic and reconstructive surgery. We present a case of silicone injection that caused pulmonary fibrosis. CASE PRESENTATION: A middle aged Transgender female underwent breast implants and silicone thigh, gluteal, and hip injections. The injections were done in by unlicensed non-physician practitioners located in a home. Two weeks after the procedures the patient developed a severe skin reaction causing infection and skin breakdown. Several weeks after recovery the breast implants opened and caused skin necrosis and infection in the breasts. A bilateral mastectomy had to be completed. After recovery the skin became thickened and fibrotic. Two years later the patient developed worsening shortness of breath, dyspnea on exertion, and hypoxia. She presented to the emergency room where a chest xray showed bilateral upper lobe infiltrates. A CT chest showed severe fibrotic changes in middle and upper lung zones. Associated groundglass opacities, mild bronchiectasis, and interlobular connective-tissue thickening in bilateral lower lobes was also present. Pulmonary function tests noted severe restrictive lung disease with severely low oxygen exchange. Pathology of surgical biopsy showed extensive multinucleated foreign body giant cells. Many of the giant cells included non-polarizable microdroplets which were suggestive of silicone droplets. DISCUSSION: Acute lung injury from venous or arterial injection is most understood complication in literature. Chronic injury causing progressive massive fibrosis is rare. When silicone is mixed with soft tissue a fibroblastic response is generated. With history, clinical findings, imaging, and pathology our suspicion of silicone injection induced lung fibrosis was confirmed. CONCLUSIONS: Silicone is considered as inert agent, physicians especially pulmonologists need to be aware of its complications which may range from local tissues necrosis to progressive massive fibrosis1. Risk of complications increases with illicit injections or if performed by unskilled practitioners. Most of the pulmonary complications due to silicon implants, described in literature are acute like acute pneumonitis or diffuse alveolar damage and only few case reports are available for chronic pulmonary pathology like Granulomatous pneumonitis and progressive massive fibrosis2, 3.Recognition of acute and chronic complications is important as treatment of chronic complications is limited. Reference #1: Narins RS, Beer K. Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential. Plast Reconstr Surg. 2006;118(3 suppl):77S–84S. Reference #2: Chastre J, Basset F, Viau F, et al. Acute pneumonitis after subcutaneous injections of silicone in transsexual men. N Engl J Med. 1983;308(13):764–767. Reference #3: Clark RF, Cantrell FL, Pacal A, et al. Subcutaneous silicone injection leading to multi-system organ failure. Clin Toxicol (Phila). 2008;46(9):834–837. DISCLOSURES: No relevant relationships by Dipen Kadaria, source=Web Response No relevant relationships by Adnan Khan, source=Web Response No relevant relationships by Anthony Mattox, source=Web Response No relevant relationships by April McDonald, source=Web Response