Prolonged Fever due to Silicone Granulomatosis

Silicone lymphadenopathy is a rare com- plication of breast implants and is often confused with metastases from breast carcinoma. Silicone breast implants have been associated with connective tissue inflammatory syndromes; however, silicone is not inert, and silicone from breast im- plants "bleeds" through the surrounding envelope and is present in the surround- ing capsule or migrates to other distant locations. We present a patient who was admitted to the hospital for investigation of prolonged fever and was eventually diagnosed with silicone granulomatous lymphadenopathy that responded to treat- ment with doxycycline. cal parameters were normal. Serology was normal including viral antibody titers against cytomegalovirus, adenovirus, Epstein-Barr virus, Q fever, Rickettsia, hu- man immunodeficiency virus, hepatitis A, B and C, Brucella and Bartonella species. All blood and urine cultures were nega- tive. Antinuclear antibodies, cytoplasmic antineutrophil cytoplasmic antibody and p-ANCA autoantibodies were negative, as was VDRL. Chest X-ray and whole-body computer- ized tomography were normal except for the right axillary lymphadenopathy mass (35 x 35 x 40 mm) with irregular borders and the silicone implants in both breasts. Transesophageal echocardiography was normal without vegetation or an atrial mass. Because of the continuous fever accompanied by severe headache, treat- ment with doxycycline tablets 100 mg twice a day was instituted. Twelve hours after starting this treatment she developed fever of 39.5˚C accompanied with chills, but after 24 hours the fever returned to normal values and remained normal for more than 3 months of follow-up. The erythrocyte sedimentation rate (90 mm/hr on admission) returned to normal values (20 mm/hour). Before starting the treatment a lymph node biopsy from the right axilla was performed, which revealed numerous giant cell granulomas accompanied by multiple vacuoles. The vacuoles partly contained an unstained non-birefringent refractile "oily" material compatible with silicone (Figure). Comment