Abstract Background Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA) encompasses autoimmune phenomena triggered by chronic exposure to immune-stimulating substances such as silicone or vaccine adjuvants. Although classically associated with systemic autoimmune symptoms, thromboembolic events have rarely been described. We present a patient with recurrent pulmonary embolism and clinical features consistent with ASIA, highlighting a potential immuno-thrombotic association. Case Presentation A 46-year-old woman with sarcoidosis (diagnosed prior to admission with elevated ACE and characteristic imaging) and BRCA1 mutation presented with pleuritic chest and neck pain and dyspnea. She reported prior illicit silicone buttock injections, after which systemic symptoms began and she developed DVT (2021) followed by recurrent PE. On this admission, CT angiography revealed bilateral pulmonary emboli and innumerable spiculated pulmonary nodules with mediastinal and hilar lymphadenopathy. Echocardiogram showed preserved biventricular function without right heart strain. Venous duplex demonstrated chronic post-thrombotic changes without acute DVT. She was managed with intravenous heparin transitioned to apixaban, and prednisone was resumed for sarcoidosis. Discussion This case illustrates a possible association between adjuvant-related immune activation and recurrent venous thromboembolism. Persistent inflammation and autoantibody production may promote endothelial dysfunction and hypercoagulability even in the absence of classic thrombophilia. Recognition of ASIA-like presentations is important when evaluating unexplained or recurrent PE. Further investigation is warranted to clarify the mechanistic links between adjuvant exposure, autoimmunity, and thrombosis. Conclusion We describe recurrent pulmonary embolism with diffuse pulmonary nodules in the context of suspected silicone-related ASIA. This case highlights the importance of considering adjuvant-induced autoimmunity as a contributor to recurrent thromboembolic and pulmonary disease. This abstract is funded by: None
Akella et al. (Fri,) studied this question.