Describe a rare case of TIPIC syndrome in a patient with breast implants.

38-year-old woman with a history of asthma, HIV, and depression complained of refractory left-sided neck pain for ten days. Pain started gradually, was sharp, radiating to the left face, and was aggravated by motion and swallowing. Three weeks before onset, she had transient respiratory infection. She denied preceding neck trauma or other neurological symptoms. Acetaminophen, oxycodone, morphine and ketorolac provided moderate, short-lived relief.

She had sex reassignment surgery including breast implants. Her home medications were spironolactone, estradiol, aripiprazole, emtricitabine and tenofovir disoproxil fumarate. She drinks alcohol occasionally. Clinical examination revealed left neck tenderness but no bruit, warmth, or swelling. Neurological examination was normal.

CT showed eccentric hypoattenuation surrounding the left distal common carotid artery and a soft intimal plaque. MRI showed enhancement surrounding the left as well as the right common carotid artery without luminal narrowing, suggestive of TIPIC.

Neck pain resolved after a short course of oral prednisone. ESR and CRP were normal. Repeated MRI after 6 months showed resolution of the perivascular inflammation.

This is the first TIPIC case reported after breast implantation, suggesting an autoimmune response. Reactivity against the left carotid plaque is an alternative cause, but it does not explain the inflammation around the right carotid artery where is no plaque. TIPIC syndrome should be differentiated from other causes of vasculitis and dissection.