Correspondence

Silicone Pneumonitis after a Cosmetic Augmentation Procedure

N Engl J Med 2006; 354:211-212January 12, 2006

Article

To the Editor:

The injection of silicone for cosmetic procedures is common practice in the United States. We describe a case of severe silicone-induced pneumonitis leading to respiratory failure. A previously healthy 30-year-old woman presented with progressive cough and shortness of breath of 10 days' duration. For cosmetic augmentation, an unlicensed nurse had given the patient two silicone injections into her buttocks 12 days and 2 days before admission. At the initial evaluation, the patient's oxygen saturation was 63 percent while she was breathing ambient air; her pulse was 119 beats per minute, blood pressure 98/66 mm Hg, respiratory rate 20 breaths per minute, and temperature 38.3°C; auscultation revealed diffuse rhonchi throughout the lungs. Her chest radiograph showed infiltrates in the lower left lobe. Laboratory studies showed a white-cell count of 13,300 per cubic millimeter and a hematocrit of 37 percent. Arterial blood gas measurements revealed respiratory alkalosis with pronounced hypoxemia.

The patient was intubated electively for impending respiratory failure, and 100 ml of bright red blood, suggestive of alveolar hemorrhage, was aspirated from the endotracheal tube. The hematocrit dropped to 22 percent. A computed tomographic (CT) scan of her chest showed diffuse bilateral ground-glass opacities (Figure 1AFigure 1CT Scan of the Chest and Lung-Biopsy Specimens.). Open-lung biopsy showed lipoid vacuoles (Figure 1B and Figure 1C), consistent with silicone pneumonitis. Light and electron microscopy confirmed the presence of elemental silicon within the vacuoles. Methylprednisolone (250 mg intravenously every six hours) was administered for five days, then gradually tapered. The patient was extubated on day 7; her oxygen saturation remained at 98 to 100 percent, and the hematocrit rose to 41 percent.

Silicone-fluid induced embolism has been implicated by several studies as a cause of acute pneumonitis with alveolar hemorrhage in patients undergoing silicone injection for tissue augmentation.1-3 The patient described here presented with symptoms similar to those of the patients in a recent study, in which 92 percent of the patients with silicone embolism had hypoxemia, 88 percent dyspnea, 70 percent fever, and 64 percent alveolar hemorrhage.2 A CT scan of the patient showed diffuse air-space disease. These results were more radiologically advanced than previously reported,4 being proportional to the severity of the clinical and pathological findings in the patient. Silicone injections for cosmetic purposes should be considered a high-risk procedure.

Grigoriy E. Gurvits, M.D.
St. Vincent's Catholic Medical Center, New York, NY 10011

4 References

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Citing Articles (9)

Citing Articles

1. 1

   Lida P. Hariri, Henning A. Gaissert, Robert Brown, Andrea Ciaranello, Reginald E. Greene, Martin K. Selig, Richard L. Kradin. (2012) Progressive Granulomatous Pneumonitis in Response to Cosmetic Subcutaneous Silicone Injections in a Patient With HIV-1 Infection: Case Report and Review of the Literature. Archives of Pathology & Laboratory Medicine 136:2, 204-207
   CrossRef

2. 2

   MATTEO C. LOPICCOLO, BENJAMIN J. WORKMAN, MARSHA L. CHAFFINS, HOLLY A. KERR. (2011) Silicone Granulomas After Soft-Tissue Augmentation of the Buttocks: A Case Report and Review of Management. Dermatologic Surgery 37:5, 720-725
   CrossRef

3. 3

   Abdulla A. Al-Ansari, Ahmed Shamsodini, Raidh A. Talib, Tawiz Gul, Ahmed A. Shokeir. (2010) Subcutaneous Cod Liver Oil Injection for Penile Augmentation: Review of Literature and Report of Eight Cases. Urology 75:5, 1181-1184
   CrossRef

4. 4

   S. Paredes Vila, F. J. Gonzalez Barcala, J. Suarez Antelo, M. Moldes Rodriguez, I. Abdulkader Nallib, L. Valdes Cuadrado. (2010) Pneumonitis caused by silicone gel following breast implant rupture. Irish Journal of Medical Science 179:1, 141-145
   CrossRef

5. 5

   Christian Weinand, Ananth S. Murthy. (2009) Liquid silicone breast cosmesis—pros and cons of a conversely discussed material in a case report of silicone pneumonia in a transsexual male. European Journal of Plastic Surgery 32:4, 209-212
   CrossRef

6. 6

   Carlos Santiago Restrepo, Maddy Artunduaga, Jorge A. Carrillo, Aura L. Rivera, Paulina Ojeda, Santiago Martinez-Jimenez, Ana C. Manzano, Santiago E. Rossi. (2009) Silicone Pulmonary Embolism. Journal of Computer Assisted Tomography 33:2, 233-237
   CrossRef

7. 7

   Jonathan Silberstein, Tracy Downs, Irwin Goldstein. (2008) Penile Injection with Silicone: Case Report and Review of the Literature. Journal of Sexual Medicine 5:9, 2231-2237
   CrossRef

8. 8

   Saleh Alazemi, Maritza M. Suarez, Horst J. Baier. (2008) Direct Migration of Liquid Silicone Oil to the Mediastinum. The American Journal of Medicine 121:2, e3-e4
   CrossRef

9. 9

   Rhoda S. Narins, Kenneth Beer. (2006) Liquid Injectable Silicone: A Review of Its History, Immunology, Technical Considerations, Complications, and Potential. Plastic and Reconstructive Surgery 118:Suppl, 77S-84S
   CrossRef