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

RATIONALE: Polydimethylsiloxane, commonly referred as silicone, is an inert liquid compound used in esthetic procedures due to its durability and thermal stability, yet the application of non-pure silicone generates risks. One of the complications is systemic embolism syndrome which is presents with...

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Autores principales: Bejarano, Alejandro, Bautista, Diego F., Sua, Luz F., Pérez, Bladimir, Lores, Juliana, Aguirre, Marisol, Fernández-Trujillo, Liliana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302641/
https://www.ncbi.nlm.nih.gov/pubmed/32541486
http://dx.doi.org/10.1097/MD.0000000000020578
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author Bejarano, Alejandro
Bautista, Diego F.
Sua, Luz F.
Pérez, Bladimir
Lores, Juliana
Aguirre, Marisol
Fernández-Trujillo, Liliana
author_facet Bejarano, Alejandro
Bautista, Diego F.
Sua, Luz F.
Pérez, Bladimir
Lores, Juliana
Aguirre, Marisol
Fernández-Trujillo, Liliana
author_sort Bejarano, Alejandro
collection PubMed
description RATIONALE: Polydimethylsiloxane, commonly referred as silicone, is an inert liquid compound used in esthetic procedures due to its durability and thermal stability, yet the application of non-pure silicone generates risks. One of the complications is systemic embolism syndrome which is presents with fever, hypoxemia, and progression to respiratory failure, diffuse alveolar damage and alveolar hemorrhage, as well as neurological alterations in one-third of the cases. Management is strictly supportive. We present the case of acute pneumonitis with alveolar hemorrhage after silicone injection. PATIENT CONCERNS: 25-year-old transsexual man, who consulted 48 hours after liquid silicone injection in the buttocks and trochanteric area, with progressive dyspnea and chest tightness, with rapid progression to respiratory failure. DIAGNOSIS: Clinical diagnosis of silicone embolism was made. Chest x-ray and CT angiography showed diffuse alveolar infiltrates and pleural effusion without evidence of acute venous thromboembolism. Bronchoscopy plus bronchoalveolar lavage showed hemorrhagic fluid, 60% macrophages with hemosiderin in cytology and negative cultures. INTERVENTION: Sedation, relaxation, pronation, and protective ventilation were implemented until hemodynamic stabilization; as well as IV steroids and antibiotics. OUTCOMES: Clinical progress was slow towards improvement with resolution of radiological or physical abnormalities. Despite severity, the patient improved satisfactorily without late sequelae. LESSONS: Silicone injection can trigger phenomena similar to that seen in fat embolism causing inflammation and immune response activation that lead to alveolar hemorrhage, diffuse alveolar damage, and acute respiratory distress syndrome. We reported pulmonary complications related to the illegal use of injected silicone for esthetic procedures.
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spelling pubmed-73026412020-06-29 Acute pneumonitis and diffuse alveolar hemorrhage secondary to silicone embolism: A case report Bejarano, Alejandro Bautista, Diego F. Sua, Luz F. Pérez, Bladimir Lores, Juliana Aguirre, Marisol Fernández-Trujillo, Liliana Medicine (Baltimore) 6700 RATIONALE: Polydimethylsiloxane, commonly referred as silicone, is an inert liquid compound used in esthetic procedures due to its durability and thermal stability, yet the application of non-pure silicone generates risks. One of the complications is systemic embolism syndrome which is presents with fever, hypoxemia, and progression to respiratory failure, diffuse alveolar damage and alveolar hemorrhage, as well as neurological alterations in one-third of the cases. Management is strictly supportive. We present the case of acute pneumonitis with alveolar hemorrhage after silicone injection. PATIENT CONCERNS: 25-year-old transsexual man, who consulted 48 hours after liquid silicone injection in the buttocks and trochanteric area, with progressive dyspnea and chest tightness, with rapid progression to respiratory failure. DIAGNOSIS: Clinical diagnosis of silicone embolism was made. Chest x-ray and CT angiography showed diffuse alveolar infiltrates and pleural effusion without evidence of acute venous thromboembolism. Bronchoscopy plus bronchoalveolar lavage showed hemorrhagic fluid, 60% macrophages with hemosiderin in cytology and negative cultures. INTERVENTION: Sedation, relaxation, pronation, and protective ventilation were implemented until hemodynamic stabilization; as well as IV steroids and antibiotics. OUTCOMES: Clinical progress was slow towards improvement with resolution of radiological or physical abnormalities. Despite severity, the patient improved satisfactorily without late sequelae. LESSONS: Silicone injection can trigger phenomena similar to that seen in fat embolism causing inflammation and immune response activation that lead to alveolar hemorrhage, diffuse alveolar damage, and acute respiratory distress syndrome. We reported pulmonary complications related to the illegal use of injected silicone for esthetic procedures. Wolters Kluwer Health 2020-06-12 /pmc/articles/PMC7302641/ /pubmed/32541486 http://dx.doi.org/10.1097/MD.0000000000020578 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 6700
Bejarano, Alejandro
Bautista, Diego F.
Sua, Luz F.
Pérez, Bladimir
Lores, Juliana
Aguirre, Marisol
Fernández-Trujillo, Liliana
Acute pneumonitis and diffuse alveolar hemorrhage secondary to silicone embolism: A case report
title Acute pneumonitis and diffuse alveolar hemorrhage secondary to silicone embolism: A case report
title_full Acute pneumonitis and diffuse alveolar hemorrhage secondary to silicone embolism: A case report
title_fullStr Acute pneumonitis and diffuse alveolar hemorrhage secondary to silicone embolism: A case report
title_full_unstemmed Acute pneumonitis and diffuse alveolar hemorrhage secondary to silicone embolism: A case report
title_short Acute pneumonitis and diffuse alveolar hemorrhage secondary to silicone embolism: A case report
title_sort acute pneumonitis and diffuse alveolar hemorrhage secondary to silicone embolism: a case report
topic 6700
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302641/
https://www.ncbi.nlm.nih.gov/pubmed/32541486
http://dx.doi.org/10.1097/MD.0000000000020578
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