Abstract Introduction Liquid silicone is often considered inert when used in controlled medical settings. However, nonmedical grade silicone injected illicitly for cosmetic enhancement can provoke severe systemic responses. Silicone Embolism Syndrome (SES) is a rare but life threatening condition that can mimic fat embolism, leading to diffuse alveolar hemorrhage (DAH) and acute respiratory distress syndrome (ARDS). High risk groups include transgender women undergoing unregulated cosmetic procedures. Description 24 year old transgender woman with HIV (on medication), undetectable viral load, presented with fever, fatigue, night sweats, myalgias, and dyspnea four days after receiving a gluteal silicone injection in an unlicensed setting. She denied IV drug use and reported working in a beauty salon. On arrival Temperature was 101.3 °F, SpO2 95% on room air, RR 22, BP 104/62. Exam noted bilateral rales; labs showed elevated ESR and fibrinogen with low procalcitonin. Initial chest X-ray showed minor peripheral opacities. Within hours, her condition worsened with hemoptysis and hypoxia. CTPA was negative for PE but showed diffuse bilateral peripheral ground-glass opacities and mediastinal lymphadenopathy. She was started on corticosteroids, broad-spectrum antibiotics, and PCP coverage. Despite this, she progressed rapidly to respiratory failure with bloody secretions, requiring mechanical ventilation under ARDS protocol. Bronchoscopy was deferred due to instability. POCUS revealed right ventricular dilation. ECMO transfer was initiated, but she suffered cardiac arrest. Autopsy confirmed silicone emboli in the lungs, brain, liver, and kidneys. Extensive infectious and autoimmune workup remained negative, including cultures, fungal and viral markers, and autoimmune panels. Discussion SES results from inadvertent intravascular silicone entry, triggering microvascular occlusion, inflammatory injury, and hemorrhage. Imaging may reveal peripheral infiltrates and ground glass changes. Diagnosis is clinical, supported by history, imaging, and postmortem findings. Management is largely supportive—ventilation, corticosteroids, and ECMO in refractory cases. This case necessitates the reason for early recognition of SES in at risk individuals and highlights the fatal consequences of unregulated cosmetic practices. This abstract is funded by: none
Shah et al. (Fri,) studied this question.