Davidson Nicholas, Lee Felicity, Lambert James, Laycock Andrew, Allanson Benjamin, Dwivedi Girish
Department of Cardiology, Fiona Stanley Hospital, Perth, Australia.
Department of Cardiology, Fiona Stanley Hospital, Perth, Australia.
JACC Case Rep. 2025 Jul 30;30(21):104357. doi: 10.1016/j.jaccas.2025.104357.
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.
心脏结节病是症状性窦房结功能障碍（SND）的罕见病因。硅胶隆胸与结节病的各种表型有关，但据我们所知，与心脏受累无关。我们报告一例50岁女性，她因症状性SND就诊，发现有硅胶乳房植入物破裂、弥漫性胸部淋巴结肿大和广泛的心脏浸润。淋巴结活检显示非坏死性肉芽肿和与结节病或弥漫性硅胶肉芽肿一致的折光性非双折射物质。患者仅取出植入物无反应，但对大剂量糖皮质激素和辅助免疫抑制（甲氨蝶呤和阿达木单抗）有显著反应。我们推测，破裂植入物中的硅胶作为一种免疫佐剂，引发了一种与结节病难以区分的佐剂型反应诱导的自身免疫/炎症综合征，这是首次描述的累及心脏的此类病例。
