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Silicone Breast Implants and Atypical Autoimmune Disease
- Eugene H. Ryan, MD; and
- Walter J. Moore, MD
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TO THE EDITOR:
Bridges and associates [1] have provided timely documentation of clinical and immunologic features in women with rheumatologic complaints after silicone augmentation mammoplasty. Human adjuvant disease is a connective tissue disorder that sometimes meets American College of Rheumatology criteria for the diagnosis of systemic lupus erythematosus, rheumatoid arthritis, progressive systemic sclerosis, mixed connective tissue disease, or unclassified rheumatic syndromes [1-5] and occurs 6 to 15 years after implantation mammoplasty [1-5]. We describe a 39-year-old white woman who had augmentation mammoplasty in 1982 and revision of a ruptured left implant in 1989 and who developed a skin rash and eye inflammation in the fall of 1990. Her skin lesions fit the description of those reported by Bridges and colleagues as an intermediate cutaneous scleroderma. Laboratory testing was noteworthy for a positive antinuclear antibody test result (titer, 1:320) using HEp-2 cells as the tissue substrate and a negative result for dsDNA by indirect immunofluorescence using Crithidia luciliae as substrate. Skin and eye inflammation persisted for months, despite therapy with topical skin and eye steroid preparations but resolved within 10 days of removal of the intact breast implants.
The rapid improvement after intact implant removal strongly suggests an association between her scleroderma-like reaction and the silicone breast implants. The episcleritis and conjunctivitis have not been described as a manifestation of this syndrome but clearly are seen in several rheumatic diseases. We agree that atypical autoimmune illness may occur in some women after placement of silicone breast implants [1].
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
