Still's-like disease, breast prosthesis, and collagen implants

Abstract

Silicone-induced connective tissue disease raises a controversial issue. We report a case of Still's disease associated with silicone and collagen implants that showed improvement on steroids, but remained steroid-dependent despite removal of the silicone implants. This observation complements four previous cases in the literature and questions the role of breast implants in the pathogenesis of Still's disease. The number of cases studied is insufficient for conclusions, but silicone-implant-associated syndrome may be confused with Still's disease. We consequently propose the use of ferritinemia and its serum glycosylated fraction level as discriminating factors. Collagen has been associated with some inflammatory diseases, but never previously with Still's disease. However, considering this observation and previous data in the literature, its role may be postulated as an exacerbating factor or a pathogenic agent.

Collagen and Its Modifications-Crucial Aspects with Concern to Its Processing and Analysis

“…Mammalian skin provides an excellent source of type I collagen for biomedical use, however, in case of bovine collagen there is a potential risks concerning infectious diseases such as BSE or Transmissible Spongiform Encephalopathy (TSE). Around 2.5%–4.0% of the population are allergic to bovine collagen . In order to minimalize undesirable immunological reactions, it is necessary to remove or chemically modify certain collagen regions.…”

When uncommon and common coalesce: adult onset Still’s disease associated with breast augmentation as part of autoimmune syndrome induced by adjuvants (ASIA)

“…Eight other cases of AOSD following SBI were described [7][8][9][10][11][12]; we had access to the full details of six of them which are summarized in Table 2. Only one patient had pleuritis and pericarditis as manifestations but was subsequently diagnosed as having systemic lupus erythematosus (SLE).…”

“…In recent years, many studies have analyzed the association between breast augmentation using silicone implants and subsequent pathologies, either local (rupture of the implantand capsular contracture) or systemic (e.g., lymphoma and connective tissue diseases) [5,6].Taken together, only eight cases of AOSD associated with breast augmentation have been reported to date [7][8][9][10][11][12]. All previous case reports were described after the decision whether to remove the breast implants was already taken.…”

Still’s-like Disease Induced by Breast Implants in a Middle-Aged Female Health Professional

“…Based on the laboratory findings, the presence of anti-silicone antibodies and foreign body granulomas in the liver confirms that an inflammatory reaction was induced by silicone and therefore silicone breast implants were the causative agent of Still-like inflammatory syndrome [3] . Although previous research found no definite evidence to support an association between silicone breast implants and autoimmune connective tissue diseases [4] , many cases indicate a potential linkage between them [5–9] . In recent years, the term autoimmune/inflammatory syndrome induced by adjuvants (ASIA) has been proposed for autoimmune conditions either primarily diagnosed or re-activated after prosthetic material has been placed in or has ruptured in the patient’s body [5] .…”