653: When Beauty Could Kill: A Case of Silicone Embolism Syndrome

Introduction: Silicone Embolism Syndrome (SES) is a complication of embolic liquid silicone injection, typically for illicit cosmetic procedures. Symptomatically patients develop dyspnea, fever, and cough or hemoptysis. The syndrome is characterized by pulmonary emboli, alveolar hemorrhage, acute respiratory distress syndrome (ARDS), and mental status changes. There is a lack of randomized evidence in treatment though it is typically supportive care with some cases showing good outcomes with steroids. Description: A 26-year-old woman with no significant medical history presented with acute, progressive shortness of breath and chest pain immediately after receiving a second set of gluteal injections of 40 mL of liquid silicone – a procedure she had received many times since she was 17. She initially presented to another hospital where she was diagnosed with community acquired pneumonia and treated with levofloxacin. The next day she presented to our facility with worsening of symptoms. Chest x-ray showed multifocal hazy opacities and areas of consolidation and CT Angiography showed patchy ground glass opacities predominantly at the peripheral lungs without evident emboli. She had rapidly worsening hypoxic respiratory failure, tachypnea and hemoptysis, requiring intubation and mechanical ventilation. Repeat radiography was consistent with ARDS and worsening pulmonary infiltrates. She was ventilated with lung protective strategies and given Solumedrol 60 mg BID after consultation with Poison Control. ECMO was considered but not required given her stability after intubation. She experienced rapidly improving respiratory status with extubation after 2 days and weaning to nasal cannula prior to transfer from intensive care. Discussion: SES is a rare but potentially life-threatening complication that occurs when liquid silicone enters the bloodstream. The FDA reports a rise in illicit injections and warns for the dangers of receiving such treatments when compared to silicone used in approved methods. Current literature suggests both an obstructive and inflammatory method to the pathophysiology of SES. It is not clear if the quantity or frequency of injections increases risk but given her presentation it is possible that this may have contributed to her presentation.