Acute pneumonitis and diffuse alveolar hemorrhage secondary to silicone embolism: A case report

Pulmonary adverse events of breast silicone implants and silicone injection

The incidence of breast implants and silicone injections has continuously increased since their FDA approval for use in the 1960's. The prevalence of overall adverse events is approximately 20%. The actual incidence of pulmonary adverse events is unknown. This review focuses on the pulmonary adverse events of breast implants and silicone injections. Vascular complications are represented by acute and chronic embolisation syndromes with a clinico-radiological presentation of alveolar hemorrhage. Inflammatory complications are numerous, including siliconoma, which is a granulomatous reaction mimicking a mesothelioma. On the other hand, there are some reports arguing a link between the development of auto-immune diseases and breast implants, such as scleroderma, rheumatoid arthritis, Sjögren's syndrome, and dermatomyositis. Finally, for patients with asthma, breast implants may contribute to poor disease control. Cases of eosinophilic granulomatosis with polyangeitis have been described. Thus, it is of interest to decipherate mechanisms and incidence of these effects in prospective studies to better manage pulmonary diseases in patients wearing breast implants in order to understand their role as culprits or bystanders. In addition, characterization of subpopulations with increased risk of adverse events is needed as we highlighted that some subpopulations seem to be at greater risk of developing them, notably asthmatics.

Fatal pulmonary embolism following injectable gluteal filler usage: a case report

BACKGROUND

Despite the fact that injectable filler usage in the gluteal region has not been recommended in formal medical institutions, illegal procedures are performed in many clinics and beauty centers across Egypt. This case report illustrates the illegal practice culminating in a fatal complication.

CASE PRESENTATION

A 26-year-old female with no relevant medical history presented to the ER with acute onset shortness of breath. The complaint started 16 h before, with a rapidly progressive course, shortly after undergoing a gluteal filler injection at a center in Cairo. At ER, the patient was severely distressed, yet fully conscious and oriented. She was shocked (BP 70/40 mmHg), tachycardic (130 BPM), and tachypneic (30/min) with normal temperature. She had congested pulsating neck veins with positive Kussmaul sign. Chest auscultation revealed normal vesicular breathing with equal air entry and no adventitious sounds. Her O2 saturation was 60% on room air that improved to 85% on O2 mask. ECG showed sinus tachycardia. Echocardiography showed dilated right side, D-shaped septum with systolic flattening, dilated IVC, mild tricuspid regurgitation and estimated RV systolic pressure 53 mmHg. Her ABG showed compensated metabolic acidosis with elevated lactate level. At the ICU, CVP was 18 mmHg. Saline infusion was continued along with noradrenaline infusion initiation. A provisional diagnosis of high-risk pulmonary embolism was made, though CT pulmonary angiography was not available. Accordingly, thrombolytic therapy was initiated with alteplase (100 mg) over 2 h. Also, a dose of pulse steroids (methylprednisolone 200 mg) was given. Chest X-ray showed bilateral heterogenous opacity and ABG showed deteriorating hypoxia and combined metabolic and respiratory acidosis. The patient was intubated upon deterioration of conscious level and was put on mechanical ventilation. Her ET tube showed frequent blood-tinged secretions. Echocardiography showed more right-side dilatation that was consistent with deterioration of clinical status. Three hours after admission the patient developed cardiac arrest and died 2 h later.

CONCLUSIONS

This case report highlights the dangers associated with injectable filler usage in the gluteal region. Physicians and patients should be aware of the possible complications and how to avoid it.