Silicone Breast Implant as a Hidden Cause of Fever: A Diagnostic Pitfall

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.