Silicone in HIV-1-infected patients: a cause of misdiagnosed granulomatous disease

Immune reconstitution inflammatory syndrome induced by gluteal silicones in a transgender woman living with HIV

We report a case of an immune reconstitution inflammatory syndrome induced by gluteal silicones in a transgender woman living with HIV following the start of antiretroviral therapy. This case resembles the autoimmune/inflammatory syndrome induced by adjuvants (ASIA) syndrome that has been described as a complication of insertions of materials such as injected or implanted silicones. The potential of developing an inflammatory response in patient with injected or implanted silicones/foreign substances should be considered in patients who have recently started antiretroviral therapy.

Inflammatory nodules following soft tissue filler use: a review of causative agents, pathology and treatment options

Nodule development is a common complication following the use of fillers for soft tissue augmentation and is commonly categorized as inflammatory or non-inflammatory in nature. Inflammatory nodules may appear anywhere from days to years after treatment, whereas non-inflammatory nodules are typically seen immediately following implantation and are usually secondary to improper placement of the filler. Although inflammatory nodules are more common with permanent fillers such as silicone, inflammatory nodule development following administration of temporary fillers such as hyaluronic acid and collagen has also been reported. Treated many times with corticosteroids due to their anti-inflammatory properties, inflammatory nodules may be secondary to infection or biofilm formation, warranting the use of alternative agents. Appropriate and prompt diagnosis is important in avoiding delay of treatment or long-term complications for the patient. This paper addresses the etiology, development, and studied treatment options available for inflammatory nodules secondary to each of the major classes of fillers. With this knowledge, practitioners may expeditiously recognize and manage this common side effect and thus maximize functional and aesthetic benefit.

Progressive Granulomatous Pneumonitis in Response to Cosmetic Subcutaneous Silicone Injections in a Patient With HIV-1 Infection: Case Report and Review of the Literature

Silicone, commonly used in cosmetic procedures owing to its presumed inertness, can yield serious sequelae including acute embolization and pneumonitis. Chronic pulmonary sequelae in response to silicone injection have not been previously described. We report a case of chronic progressive granulomatous pneumonitis in response to subcutaneous silicone injections in a transgender male-to-female patient infected with human immunodeficiency virus 1 (HIV-1). After receiving silicone injections to the buttock, the patient developed rapid onset dyspnea, pleuritic chest pain, fever, and chills. Chest computed tomography revealed diffuse peripheral interstitial opacities. She responded symptomatically to prednisone with subsequent intermittent symptomatic flares. Four years later, she developed marked dyspnea and cough. Chest computed tomography showed progressive diffuse ground-glass and nodular opacities. Lung biopsies demonstrated numerous spheroid silicone particles within the lung interstitium and small pulmonary vessels, surrounded by foreign body giant cells and nonnecrotizing granulomatous inflammation. We speculate that HIV-1–infected patients may be at risk for chronic, progressive granulomatous pneumonitis due to silicone injection years after their procedure owing to shifting levels of cell-mediated immunity.