Cardiac Granulomatous Disease Following Silicone Breast Augmentation

Cardiac sarcoidosis is a rare cause of symptomatic sinoatrial node dysfunction (SND). Silicone breast augmentation has been associated with various phenotypes of sarcoidosis, but not to our knowledge with cardiac involvement. We present a case of a 50-year-old woman who presented with symptomatic SND and was found to have silicone breast implant rupture, disseminated thoracic lymphadenopathy, and extensive cardiac infiltration. Lymph node biopsy demonstrated non-necrotizing granuloma and refractile nonbirefringent material consistent with sarcoidosis or disseminated silicone granulomatosis. The patient did not respond to implant removal alone, but demonstrated a significant response to high-dose glucocorticoids and adjuvant immunosuppression (methotrexate and adalimumab). We hypothesize that silicone from the ruptured implants served as an immunologic adjuvant triggering an autoimmune/inflammatory syndrome induced by adjuvants-type reaction indistinguishable from sarcoidosis, of which this is the first described involving the heart.