Peripheral blood eosinophilia, hyperimmunoglobulinemia A and fatigue: Possible complications following rupture of silicone breast implants

Background: Silicone breast implantation has been considered quite safe and of major cosmetic value. Immunologic sequelae such as collagen vascular diseases have not been confirmed in large studies. Objective: We describe a 55-year-old woman who developed severe fatigue, peripheral blood eosinophilia, and hyperimmunoglobulinemia A after rupture of a silicone breast implant during closed manual manipulation to lyse fibrotic tissue. Methods: We charted evidence for eosinophilia over a 19-year period and determined quantitative immunoglobulins, and lymphocyte subsets by FAGS analysis. Results: Peripheral eosinophilia in 1976 was 693/mm(3) and increased to 1360/mm(3) after rupture of the implant in 1992. Serum immunoglobulin A was 332 mg/dL in 1976 and ranged after rupture from 473 to 627 mg/dL without other cause, Fatigue was not reversed with a parenteral corticosteroid injection. CD4 and CD8 subsets were normal but 40% of CD3 cells were Ia positive although not CD25 positive (IL2 receptor), Only 5% of B cells were CD19CD23 positive despite the high concentration of serum IgA. Conclusion: This case is an example of a previously unreported apparent adverse effect of silicone-breast implant rupture with persisting eosinophilia, hyperimmunoglobulinemia A, and fatigue.