An Interesting Case Of Silicone Embolism Syndrome After A Cosmetic Procedure

SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Cosmetic silicone injection is an increasingly popular procedure with potentially fatal complications. It is currently not approved for body augmentation purposes. Risk of adverse events increases when performed by unlicensed providers in nonsterile settings. One feared complication is silicone embolism syndrome (SES). Signs and symptoms of SES include dyspnea, pleuritic chest pain, hypoxemia, fever, and petechial rash. One-third of patients also develop neurologic symptoms. Here, we describe a case of SES after silicone injection for buttock augmentation that improved rapidly with systemic corticosteroids. CASE PRESENTATION: A 40 year old woman with a history of uterine fibroids presented with progressive dyspnea, nonproductive cough, and pleuritic chest pain for one week after vacationing in Mexico. Outpatient treatment for a presumed viral respiratory infection did not improve her symptoms. Computed tomography scan of the chest revealed multifocal bilateral peripheral infiltrates. The patient was empirically treated for atypical pneumonia with antibiotics. Antifungals were also started, as the patient visited several underwater caves during her trip. On a subsequent exchange, it was revealed that she had received silicone injections for buttock augmentation during her trip. A bronchoscopy with transbronchial biopsies of the left lung was performed. The patient was started on systemic corticosteroids with significant improvement in both symptoms and hypoxemia. Histopathology of the biopsy specimen revealed increased vacuolar globules within pulmonary vasculature with alveolar macrophages, eosinophils, and lymphocytes, confirming the diagnosis of silicone embolism syndrome. DISCUSSION: The pathophysiology of silicone embolism syndrome is similar to other embolic syndromes. Small silicone globules travel through systemic circulation and collect in the pulmonary vascular bed. Obstruction of pulmonary capillaries leads to increased pulmonary artery pressure, ventilation/perfusion mismatch, increased dead space ventilation, and even right ventricular failure and obstructive shock in severe cases. Additionally, circulating silicone may have prothrombotic effects that lead to further obstruction, pneumonitis, edema, and even hemorrhage. Silicone (known industrially as polydimethylsiloxane) is generally thought to be an inert material. However, seeding of this substance in the pulmonary vascular bed has been shown to induce an inflammatory reaction that can lead to SES. CONCLUSIONS: The use of steroid therapy in SES is not well established in literature. Treatment of SES has been mostly supportive. In our case, systemic corticosteroids may have decreased inflammation leading to rapid improvement in symptoms. Reference #1: Schmid, A.; Tzur, A.; Leshko, L.; Krieger, B.P. Silicone embolism syndrome: a case report, review of the literature, and comparison with fat embolism syndrome. Chest. 2005 Jun;127(6):2276-81. Reference #2: 2018 National Plastic Surgery Statistics. American Society of Plastic Surgeons. https://www.plasticsurgery.org/documents/News/Statistics/2018/plastic-surgery-statistics-report-2018.pdf DISCLOSURES: no disclosure on file for Ronaldo Gnass; No relevant relationships by Joseph Mak, source=Web Response No relevant relationships by Suman Thapamagar, source=Web Response No relevant relationships by Abdul Hameed Zaid, source=Web Response