Still's-like disease, breast prosthesis, and collagen implants

Silicone-induced connective tissue disease raises a controversial issue. We report a case of Still's disease associated with silicone and collagen implants that showed improvement on steroids, but remained steroid-dependent despite removal of the silicone implants. This observation complements four previous cases in the literature and questions the role of breast implants in the pathogenesis of Still's disease. The number of cases studied is insufficient for conclusions, but silicone-implant-associated syndrome may be confused with Still's disease. We consequently propose the use of ferritinemia and its serum glycosylated fraction level as discriminating factors. Collagen has been associated with some inflammatory diseases, but never previously with Still's disease. However, considering this observation and previous data in the literature, its role may be postulated as an exacerbating factor or a pathogenic agent.