Kidney Involvement in Asia Syndrome: Case Report of an Uncommon Nephrotic Syndrome

Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) first described in 2011, includes several immune- mediated diseases that are likely to develop in genetically predisposed individuals leading to hyperstimulation of the immune system after their exposure to an adjuvant (vaccine compounds, silicone implant, drugs, infections, metals, etc.). Compared with other clinical manifestations (myalgia, arthralgia, chronic fatigue, neurological manifestations, pyrexia), the description of the renal involvement is very rare. We report a case of nephrotic syndrome in a 37-year-old woman with bilateral silicon breast implant placed in 2017 for cosmetic reason. Kidney biopsy showed acute interstitial tubular nephritis with aspects of membranoproliferative glomerulonephritis. In the months before diagnosis our patient manifested symptoms which oriented for other disease (i.e. Sjogren’s, IgG 4 disease, lymphoproliferative issues). Glucocorticoid treatment did not improve while steroids-related side effects appeared. Implant revision was surprisingly found a broken implant, which after its removal and replacement, led to complete remission of the nephrotic syndrome. Compare with other clinical manifestations, renal involvement in ASIA Syndrome is scanty. Our findings may help physicians, such as general practitioners, plastic surgeons and internists, to recognize this pattern of systemic symptoms in women with breast silicone implants and unexplained symptoms.