Cosmetic Surgical Procedures and Connective Tissue Disease: The Cleopatra Syndrome Revisited

Editorials15 June 1993Cosmetic Surgical Procedures and Connective Tissue Disease: The Cleopatra Syndrome RevisitedMarc C. Hochberg, MD, MPHMarc C. Hochberg, MD, MPHUniversity of Maryland at Baltimore, Baltimore, MD 21201-1734.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-118-12-199306150-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail During the past 30 years, numerous authors have reported single patients as well as case series of patients with presumed and well-defined connective tissue diseases after cosmetic surgical procedures. These include reports of the development of systemic sclerosis and other connective tissue diseases after augmentation mammoplasty with injections of paraffin and silicone, as well as placement of silicone gel-filled breast prostheses, and a dermatomyositis or polymyositis-like syndrome after bovine collagen implants.The case series reported by Bridges and colleagues, in this issue of Annals, is another series of patients referred to rheumatologists interested in a potential silicone-rheumatic disease link, for ...References1. Miyoshi K, Miyaoka T, Kobayashi Y, Itakura T, Nishijo K, Higashibara M, et al. Hypergammaglobulinemia by prolonged adjuvanticity in man: disorders developed after augmentation mammoplasty. Ijishimpo. 1964; 2122:9-14. Google Scholar2. Kumagai Y, Shiokawa Y, Medsger TA Jr, Rodnan GP. Clinical spectrum of connective tissue disease after cosmetic surgery: observations on eighteen patients and a review of the Japanese literature. Arthritis Rheum. 1984; 27:1-12. Google Scholar3. Weisman MH, Vecchione TR, Albert D, Moore LT, Mueller MR. Connective-tissue disease following breast augmentation: a preliminary test of the human adjuvant disease hypothesis. Plast Reconstr Surg. 1988; 82:626-30. Google Scholar4. Germain BF. Silicone breast implants and rheumatic disease. Bull Rheum Dis. 1992; 41:1-5. Google Scholar5. Kessler DA. The basis of the FDA's decision on breast implants. N Engl J Med. 1992; 326:1713-5. Google Scholar6. Brody GS, Conway DP, Deapen DM, Fisher JC, Hochberg MC, LeRoy EC, et al. Consensus statement on the relationship of breast implants to connective-tissue disorders. Plast Reconstr Surg. 1992; 90:1102-5. Google Scholar7. Fletcher RH, Fletcher SW, Wagner EH. Clinical Epidemiology: the Essentials, 2nd ed. Baltimore: Williams & Wilkins; 1988:188-207. Google Scholar8. Bridges AJ, Conley C, Wang G, Burns DE, Vasey FB. A clinical and immunologic evaluation of women with silicone breast implants and symptoms of rheumatic disease. Ann Intern Med. 1993; 118:929-37. Google Scholar9. Press RI, Peebles CL, Kumagai Y, Ochs RL, Tan EM. Antinuclear antibodies in women with silicone breast implants. Lancet. 1992; 340:1304-7. Google Scholar10. Cukier J, Beauchamp RA, Spindler JS, Spindler S, Lorenzo C, Trentham DE. Association between bovine collagen dermal implants and a dermatomyositis or a polymyositis-like M30467 syndrome. Ann Intern Med. 1993; 118:920-8. Google Scholar11. Dalakis MC. Polymyositis, dermatomyositis, and inclusion-body myositis. N Engl J Med. 1991; 325:1487-98. Google Scholar12. Hochberg MC. Polymyositis/dermatomyositis. In: Silman AJ, Hochberg MC, eds. Epidemiology of the Rheumatic Diseases. Oxford: Oxford University Press; 1993; (In press). Google Scholar13. Goldstein R, Duvic M, Targoff IN, Reichlin M, McMenemy AM, Reveille JD, et al. HLA-D region genes associated with autoantibody responses to histidyl-transfer RNA syntetase (Jo-1) and other translation-related factors in myositis. Arthritis Rheum. 1990; 33: 1240-8. Google Scholar14. Leff RL, Burgess SH, Miller FW, Love LA, Targoff IN, Dalakas MC, et al. Distinct seasonal patterns in the onset of adult idiopathic inflammatory myopathy in patients with anti-Jo-1 and anti-signal recognition particle autoantibodies. Arthritis Rheum. 1991; 34: 1391-6. Google Scholar15. Magid SK, Kagen LJ. Serologic evidence for acute toxoplasmosis in polymyositis-dermatomyositis: increased frequency of specific anti-toxoplasma IgM antibodies. Am J Med. 1983; 75:313-20. Google Scholar16. Christensen ML, Pachman LM, Schneiderman R, Patel DC, Friedman JM. Prevalence of Coxsackie B virus antibodies in patients with juvenile dermatomyositis. Arthritis Rheum. 1986; 29:1365-70. Google Scholar17. Strongwater SL, Dorovini-Zis K, Ball RD, Schnitzer TJ. A murine model of polymyositis induced by coxsackie-virus B1 (Tucson strain). Arthritis Rheum. 1984; 27:433-42. Google Scholar18. Safavi KH, Heyse SP, Hochberg MC. Estimating the incidence and prevalence of rare rheumatologic diseases. A review of methodology and available data sources (Editorial). J Rheumatol. 1990; 17: 990-3. Google Scholar19. Oddis CV, Conte CG, Steen VD, Medsger TA Jr. Incidence of polymyositis-dermatomyositis: a 20-year study of hospital diagnosed cases in Allegheny County, PA, 1963-82. J Rheumatol. 1990; 17: 1329-34. Google Scholar20. DeLustro F, Fries J, Kang A, Katz S, Kaye R, Reichlin M. Immunity to injectable collagen and autoimmune disease: a summary of current understanding. J Dermatol Surg Oncol. 1988; 14:57-65. Google Scholar21. Miller FW. Pathogenesis, pp 150-3. In: Plotz PH, moderator. Current concepts in the idiopathic inflammatory myopathies: polymyositis, dermatomyositis, and related disorders. Ann Intern Med. 1989; 111:143-57. Google Scholar22. Lyon MG, Bloch DA, Hollak B, Fries JF. Predisposing factors in polymyositis-dermatomyositis: results of a nationwide survey. J Rheumatol. 1989; 16:1218-24. Google Scholar23. Wigley FM, Miller R, Hochberg MC, Steen V. Augmentation mammoplasty in patients with systemic sclerosis: data from the Baltimore Scleroderma Research Center and Pittsburgh Scleroderma Data Bank (Abstract). Arthritis Rheum. 1992; 35:S46. Google Scholar24. Moss AJ, Hamburger S, Moore RM Jr, Jeng LL. Use of selected medical device implants in the United States, 1988. Advance data from vital and health statistics; no 191. Hyattsville, Maryland; National Center for Health Statistics; 1990. Google Scholar Author, Article, and Disclosure InformationAuthors: Marc C. Hochberg, MD, MPHAffiliations: University of Maryland at Baltimore, Baltimore, MD 21201-1734.Corresponding Author: Marc C. Hochberg, MD, MPH, Departments of Medicine and Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 419 West Redwood Street, Suite 620, Baltimore, MD 21201. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAssociation between Bovine Collagen Dermal Implants and a Dermatomyositis or a Polymyositis-like Syndrome Jean Cukier , Richard A. Beauchamp , Joseph S. Spindler , Sarah Spindler , Carlos Lorenzo , and David E. Trentham A Clinical and Immunologic Evaluation of Women with Silicone Breast Implants and Symptoms of Rheumatic Disease Alan J. Bridges , Carol Conley , Grace Wang , David E. Burns , and Frank B. 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