A CASE OF BRONCHIECTASIS AFTER SILICONE GLUTEAL AUGMENTATION

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bronchiectasis is a chronic condition with pathogenic airway dilation and bronchial wall thickening that has been associated with many different causes. One of the less studied causes is silicone exposure. CASE PRESENTATION: This is a 33 year-old female with a history of supraventricular tachycardia, chronic respiratory failure due to bronchiectasis, and pulmonary hypertension group 3 presented with increased work of breathing and lethargy. She appeared uncomfortable with tachypnea and hypoxia requiring an increase of her baseline home oxygen. ABG was consistent with acute hypercapnic respiratory failure and thus she was placed on Bi-level with improvement in hermental status. Chest radiograph showed hyperinflated lungs and diffuse bronchiectasis bilaterally. Computed tomography showed extensive severe bilateral cystic bronchiectasis. She had multiple recurrent admissions for hypercapnic respiratory failure due to progression of her bronchiectasis with superimposed bacterial pneumonia and colonization. She had an extensive work up to assess for an underlying etiology for her bronchiectasis which began at age 18 with mild disease. Full rheumatologic evaluation was unrevealing. Her pulmonary function tests revealed a severe mixed defect with an FEV1/FVC of 58, FEV1 0.57 (22%), and FVC 0.98 (33%), TLC 4L. However, her respiratory status declined rapidly after she had a silicone gluteal augmentation surgery in 2015 which was "botched." She was treated with steroids and intravenous antibiotics and was discharged home on home oxygen. DISCUSSION: In recent years there has been a rise in cases of silicosis due to modern industries; however, a less studied phenomenon is that of lung disease as a complication of silicone breast and gluteal implants. The pathogenesis of silicosis is due to sIlica particles deposited in the distal airways, engulfed by alveolar macrophages leading to an upregulation of pro inflammatory and pro fibrotic pathways. Further silica ingestion by the macrophages leads to autophagy and release of intracellular silica thus attracting more macrophages with the release of cytotoxic antioxidants, proteases, and inflammatory cytokines. This leads to fibrosis and alveolitis. Bronchiectasis results from the destruction of connective tissue due to proteases with chronic inflammation leading to a host susceptible to recurrent infections, leading to further inflammation and progression of bronchiectasis. CONCLUSIONS: This case highlights the need for physicians to be aware of the potential adverse pulmonary effects, although rare, of silicone implants. This particular patient most likely suffered progression of bronchiectasis with both a restrictive and obstructive disease due to silicosis from the gluteal implants. REFERENCE #1: Barnes, Hayley, et al. "Silica-Associated Lung Disease: An Old-World Exposure in Modern Industries." Wiley Online Library, John Wiley & Sons, Ltd, 13 Sept. 2019 REFERENCE #2: King, Paul T. "The Role of the Immune Response in the Pathogenesis of Bronchiectasis." BioMed Research International, Hindawi, 18 Mar. 2018 REFERENCE #3: Schierbeck, Juliane, et al. "Silicone Implant Incompatibility Syndrome (SIIS) in a 57-Year-Old Woman with Unilateral Silicone Breast Implant." BMJ Case Reports, 2017, doi:10.1136/bcr-2016-218709 DISCLOSURES: No relevant relationships by Nourhan Kika, source=Web Response No relevant relationships by Nisha Patel, source=Web Response No relevant relationships by Anthony Saleh, source=Web Response