Can silicone breast implants be a cause of fever of unknown origin (FUO)?/nTwo patients in their fo

Fråga: Can silicone breast implants be a cause of fever of unknown origin (FUO)?

Two patients in their forties who have had augmentative silicone implants for 7 and 20 years respectively present now with unclear fever.

Sammanfattning: In a patient with silicone breast implants who present with unexplained fever, local complications such as rupture should be carefully looked for. Moreover, considering the fact that the risk of developing connective tissue diseases in women with silicone implants has not yet been conclusively assessed, these conditions should also be considered.

Svar: Possible long-term health effects of silicone breast implants, most notably breast cancer and connective tissue disease have been a matter of debate (1-3). This has been influenced by much public attention and fueled by litigation cases.

Since connective tissue disease as well as malignancy are known causes of fever of unclear origin (FUO) (4), these conditions deserve special attention in patients with silicone implants.

In spite of a huge body of published data, the issue has hitherto not been settled. While case reports (reviewed in reference 5) might suggest an increased risk of developing autoimmune diseases, the epidemiological evidence does not support an association (6,7).

The postulated relation between breast augmentation and the subsequent risk of developing breast cancer is mainly based on animal data and has not been substantiated (3). Although silicone-implanted rats demonstrated an excess number of sarcomas, the applicability of this finding in humans has been considered unlikely (3). Also, so far conducted epidemiological studies do not indicate that the use of silicone breast implants entails a significant risk of breast cancer (8,9).

We found one case report describing periodic fever (39-40 C) in a 60-year-old woman who has had augmentative breast silicone implants for 20 years (10). An extensive investigation revealed a ruptured implant with a silicone granuloma without any evidence of systemic inflammatory response. Bacteriological, viral and immunulogical laboratory tests, were all negative. It should, however, be pointed out that the lack of a general inflammatory reaction in this case can probably be explained by the concomitant use of colchicine. 1 Goldberg EP: Evaluating the health risks of breast implants. N Engl J Med 1996; 335: 1154-1156 2 Vasey FB, Aziz N: Breast implants and connective-tissue diseases. N Engl J Med 1995; 333: 1423-1424 3 Lamm SH: Silicone breast implants and long-term health effects: when are data adequate? J Clin Epidemiol 1995; 48: 507-511 4 Harrison´s, Principles of internal medicine. 1994; 13th ed: 85-89 5 Sanchez-Guerrero J, Schur PH, Sergent SJ, Liang MH: Silicone breast implants and rheumatic disease. Clinical, immunologic, and epidemiologic studies. Arthritis & Rheumatism 1994; 37: 158-168 6 Gabriel SE, O´Fallon WM, Kurland LT, Beard CM, Woods JE, Melton LJ III: Risk of connective-tissue diseases and other disorders after breast implantation. N Engl J Med 1994; 330: 1697-1702 7 Sanchez-Guerrero J, Colditz GA, Karlson EW, Hunter DJ, Speizer FE, Liang MH: Silicone breast implants and the risk of connective-tissue diseases amd symptoms. N Engl J Med 1995; 332: 1666-1670 8 Berkel H, Birdsell DC, Jenkins H: Breast augmentation: a risk factor for breast cancer? N Engl J Med 1992; 326: 1649-1653 9 Deapen DM, Brody GS: Augmentation mammaplasty and breast cancer: a 5-year update of the Los Angeles study. Plast Reconstr Surg 1992; 89: 10 Schlienger JL, Haenel P, Jaeck D: Fievre periodique au long cours et prothese mammaire. Rev Med Interne 1994; 15: 557-559