A 37-year-old Caucasian woman presented with subacute, symmetrical inflammatory
arthralgia, which was affecting her work. Apart from
fatigue, she had no other constitutional symptoms. She had undergone cosmetic bilateral
silicone breast implant surgery in 2008. Blood tests revealed erythrocyte sedimentation rate 53 mm/h, weakly positive
antinuclear antibodies and
IgG cardiolipin antibody, while breast ultrasound revealed a ruptured left
silicone implant. The working diagnosis was systemic inflammatory disease of uncertain origin. She decided to have replacement, rather than removal, of her
silicone breast implants privately, but her symptoms persisted postoperatively with a new
erythema multiforme-like
rash despite treatment with
methotrexate and moderate dose
prednisolone. Following further consultation with a National Health Service breast surgeon, her
silicone implants were removed. Within 10 weeks of surgery, all immunomodulatory treatment was discontinued with complete symptom and inflammatory response resolution. This case illustrates that implant
silicone can induce clinically significant systemic inflammatory disease and implant removal is essential for disease resolution.