# Autoimmune syndrome induced by adjuvants (ASIA) following urethral sling placement: A case report

## TL;DR

A 39-year-old woman developed autoimmune-like symptoms after a synthetic mesh sling implant, which resolved after the mesh was removed and replaced with an autologous sling.

## Contribution

This case report presents a potential link between synthetic mesh implants and autoimmune-like symptoms, resolved through surgical removal.

## Key findings

- Symptoms resolved after surgical removal of the synthetic mesh and replacement with autologous tissue.
- The case supports a temporal association between mesh implantation and autoimmune-like symptoms consistent with ASIA.
- Multidisciplinary evaluation is crucial in unexplained systemic illness following mesh implantation.

## Abstract

A 39-year-old woman developed debilitating systemic symptoms following the placement of a synthetic mid-urethral sling for stress urinary incontinence. Previously in good health, she experienced sepsis and adrenal crisis immediately postoperatively, followed by persistent symptoms including fatigue, postural orthostatic tachycardia syndrome (POTS), neuropathic pain, cognitive dysfunction, autonomic instability, and recurrent infections. Despite extensive multispecialty evaluations, no definitive diagnosis was initially reached. Laboratory testing later revealed positive ANA and mild immune dysregulation. Given her complex autoimmune history, strong family predisposition, and the temporal association with mesh implantation, her presentation was suspected to be consistent with autoimmune syndrome induced by adjuvants (ASIA). She elected to undergo surgical removal of the synthetic sling with placement of an autologous rectus fascia pubovaginal sling. Postoperatively, the patient experienced significant resolution of her symptoms, restored bladder function, and improved quality of life. This case demonstrates a temporal association consistent with ASIA, with complete symptom resolution by 3 months post-explant and sustained well-being at 1 year.

•39-year-old woman developed autoimmune-like symptoms following placement of transobturator polypropylene sling.•Autoimmune Syndrome Induced by Adjuvants (ASIA), supported by temporal association between mesh implantation &symptoms•Surgical explantation with autologous rectus fascia resulted in near-complete resolution of symptoms.•Need for multidisciplinary evaluation in unexplained systemic illness following sling.•Potential association between synthetic mesh & immune activation, reinforcing individualized management.

39-year-old woman developed autoimmune-like symptoms following placement of transobturator polypropylene sling.

Autoimmune Syndrome Induced by Adjuvants (ASIA), supported by temporal association between mesh implantation &symptoms

Surgical explantation with autologous rectus fascia resulted in near-complete resolution of symptoms.

Need for multidisciplinary evaluation in unexplained systemic illness following sling.

Potential association between synthetic mesh & immune activation, reinforcing individualized management.