Silicone Pneumonitis after a Cosmetic Augmentation Procedure

Abstract

To the Editor: The injection of silicone for cos-metic procedures is common practice in the Unit-ed States. We describe a case of severe silicone-induced pneumonitis leading to respiratory failure. A previously healthy 30-year-old woman present-ed 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. Labora-tory studies showed a white-cell count of 13,300 per cubic millimeter and a hematocrit of 37 per-cent. Arterial blood gas measurements revealed respiratory alkalosis with pronounced hypoxemia. The patient was intubated electively for impend-ing respiratory failure, and 100 ml of bright red blood, suggestive of alveolar hemorrhage, was as-pirated from the endotracheal tube. The hemato-crit dropped to 22 percent. A computed tomo-graphic (CT) scan of her chest showed diffuse bilateral ground-glass opacities (Fig. 1A). Open-lung biopsy showed lipoid vacuoles (Fig. 1B and 1C), consistent with silicone pneumonitis. Light and electron microscopy confirmed the presence of elemental silicon within the vacuoles. Methyl-prednisolone (250 mg intravenously every six hours) was administered for five days, then gradu-ally tapered. The patient was extubated on day 7; her oxygen saturation remained at 98 to 100 per-cent, and the hematocrit rose to 41 percent. Figure 1. CT Scan of the Chest and Lung-Biopsy Specimens. A CT scan of the chest (Panel A) shows bilateral, diffusely distributed ground-glass opacities with super-imposed dependent areas of consolidation. Biopsy specimens from the left lung (Panels B and C) show multiple lipoid vacuoles throughout the alveolar inter-stitium and focal thromboembolic occlusion of pulmo-nary-artery branches, consistent with silicone emboli-zation.