Case 2 -

Silicone Embolism Teri Franks Armed Forces Institute of Pathology Washington, DC

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Click here to download handout for the current section (1.26 MB) Clinical History A 22-year-old HIV-positive, transsexual male presented to the emergency department with a four-day history of fever, chest tightness, cough, and increasing dyspnea. Admission physical examination was notable for somnolence, a temperature of 99.7°F, tachypnea, and tachycardia. Arterial blood gas measurements on room air were pH 7.40, PaCO2 38 mm Hg, PaO2 67 mm Hg, and oxygen saturation 92%. Patchy, bilateral, and strikingly peripheral areas of consolidation were present on the PA chest radiograph; similar findings were more clearly demonstrated on chest CT. At bronchoscopy, fresh blood was present in the mainstem bronchi. BAL fluid cell count included 50% PMN's, 44% macrophages, 4% lymphocytes, and 2% eosinophils. Special stains and cultures for bacteria, fungi, and mycobacteria were negative. Antiglomerular basement membrane antibody, antinuclear antibody, antineutrophilic cytoplasmic antibody, cryoglobulins, and drug screen for cocaine were negative. IV methylprednisolone was administered and resulted in rapid clinical and radiologic improvement. The patient was discharged home without further treatment on the sixth hospital day. Case 2 - Figure 1 This section of lung demonstrates multiple vacuoles within the capillaries and interstitium of the alveolar walls. In the clinical setting of a transsexual male with dyspnea, the vacuoles represent silicone emboli.