Silicone-Associated Still’s-Like Inflammatory Syndrome after Ruptured Silicone Breast Implant Treated with Adalimumab: A Case Report

Silicone breast implants have been associated with systemic inflammatory and autoimmune-like syndromes, although the underlying mechanisms remain debated. We report the case of a 49-year-old woman who presented with several months of chronic fever, profound fatigue, anemia, polyarthralgia, dyspnea on exertion, and markedly elevated inflammatory markers. Ongoing symptoms prompted evaluation of her silicone breast implants, and imaging revealed rupture of a silicone breast implant, leading to bilateral implant removal. Despite explantation, systemic symptoms and inflammation persisted. Subsequent evaluation demonstrated non-necrotizing granulomatous inflammation on liver biopsy, with elemental analysis compatible with the presence of silicone-associated material beyond the implant site, and bone marrow biopsy revealed vacuolated histiocytes consistent with silicone deposition, compatible with the presence of silicone-associated material beyond the implant site. Extensive infectious, malignant, and autoimmune evaluations were unrevealing. Based on these findings and her clinical course, her silicone breast implants were considered a potential associative trigger for a silicone-associated Still’s-like inflammatory syndrome. Initial treatment with prednisone resulted in symptomatic improvement; however, attempts at dose reduction were followed by disease relapse. Sequential treatment with methotrexate, azathioprine, and tocilizumab failed to achieve sustained disease control. Initiation of adalimumab, a tumor necrosis factor (TNF)-α inhibitor, was associated with clinical improvement and normalization of inflammatory markers during the available follow-up period. This case highlights a silicone-associated Still’s-like inflammatory syndrome that persisted despite explantation and multiple immunosuppressive therapies, and suggests a potential role for TNF-α inhibition in selected patients with ongoing systemic inflammation following silicone breast implantation.