Kunitomo Kotaro, Yoshimura Fumitaka, Kubosaki Junko, Tsuji Takahiro
General Medicine, National Hospital Organization Kumamoto Medical Center, Kumamoto, JPN.
Cureus. 2025 Jul 30;17(7):e89083. doi: 10.7759/cureus.89083. eCollection 2025 Jul.
A 56-year-old woman developed a persistent fever following right transurethral ureterolithotripsy. Approximately two weeks prior to the onset of fever, she had sustained chest trauma and had a 20-year history of bilateral silicone breast implants. Physical examination, including breast assessment, was unremarkable. Blood cultures and CT revealed no identifiable source of infection. Despite treatment with broad-spectrum antibiotics and ureteral stenting, her fever and elevated CRP levels persisted. MRI revealed irregular margins and internal high-signal linear structures in the left breast implant on T2-weighted imaging, suggestive of intracapsular rupture. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) was suspected, and bilateral implant removal was subsequently performed. Her symptoms resolved following surgery. The diagnosis of ASIA was supported by fulfillment of three major criteria: exposure to silicone, presence of typical systemic symptoms (fever, fatigue, and sleep disturbance), and resolution of symptoms after implant removal. ASIA is a rare immune-mediated condition triggered by exposure to adjuvants such as silicone breast implants. Diagnosis can be especially challenging in the absence of local symptoms at the implant site. This case highlights the importance of considering ASIA in patients presenting with unexplained systemic inflammation and a history of silicone implants, even when local signs are lacking. MRI played a key role in detecting the implant rupture and guiding appropriate intervention.
一名56岁女性在接受经尿道右侧输尿管碎石术后出现持续发热。发热开始前约两周，她曾遭受胸部创伤，并有20年双侧硅胶乳房植入史。体格检查，包括乳房评估，均无异常。血培养和CT检查未发现明确的感染源。尽管使用了广谱抗生素并置入输尿管支架，她的发热及CRP水平仍持续升高。MRI显示左侧乳房植入物在T2加权成像上边缘不规则且内部有高信号线性结构，提示包膜内破裂。怀疑为佐剂诱导的自身免疫/炎症综合征（ASIA），随后进行了双侧植入物取出术。术后她的症状得到缓解。ASIA的诊断符合三项主要标准：接触硅胶、存在典型全身症状（发热、疲劳和睡眠障碍）以及植入物取出后症状缓解。ASIA是一种由接触佐剂如硅胶乳房植入物引发的罕见免疫介导疾病。在植入部位无局部症状时，诊断可能尤其具有挑战性。该病例强调了对于出现不明原因全身炎症且有硅胶植入史的患者，即使缺乏局部体征，考虑ASIA的重要性。MRI在检测植入物破裂及指导适当干预方面发挥了关键作用。
