Fever, Rash, and Arthritis in a Woman with Silicone Gel Breast Implants (original) (raw)

1997, Western Journal of Medicine

for the evaluation of fever, rash, and arthritis. Her medical history began in 1990 when bilateral silicone gel breast implants were inserted for cosmetic reasons. These implants were replaced in January 1996, when capsular contracture and substantial hardening developed. About three weeks after the operation, the patient noted a rash under her left breast that spread rapidly to her torso and extremities. The rash was described as pink, maculopapular, nonconfluent, and mildly pruritic. She noted that it waxed and waned but usually was most prominent in the evenings. In April 1996 she noted pain, stiffness, and swelling in the wrists, knees, ankles, and the interphalangeal joints of her hands. A persistent sore throat developed, and she had intermittent fevers to 38.90C (1020F) that were more frequent and severe later in the day and often were accompanied by the rash. She treated herself with ice packs and topical emollients but achieved only minor relief. In August 1996 the patient sought advice from her primary care physician when, in addition to the persistent rash and arthritis, her temperature rose to 400C (104°F). She was admitted to an outside hospital for evaluation. Laboratory evaluation at that time was notable for a leukocytosis (leukocyte count, 23 X 109 per liter [23,000 per mm3]), anemia (hematocrit, 0.30 [30%]), and elevated aminotransferase values (aspartate and alanine aminotransferase, both 120 units per liter). In addition, her serum alkaline phosphatase (400 units