We read with interest the case reported by Mir et al. on the development of SLE 2 years following the implantation of silicone breast implants. This is an outstanding case to illustrate the complex link between adjuvant and induction of autoimmunity that underpins the description of the ASIA syndrome. The etiopathogenesis of SLE is not fully understood; however, it is believed to be due to a loss of tolerance of the immune system that leads to the production of various autoantibodies. Over recent decades, SLE onset and/or exacerbation has been reported following different types of adjuvants, especially microbial agents, drugs and also vaccines. A decade ago, we reported a summary of 10 cases of SLE following hepatitis B virus (HBV) vaccine, and all of them were women patients. The mean latency period from the first HBV immunization and onset of autoimmune symptoms was 56.3 days. Two of the patients had a personal history of autoimmunity and two a familial history of autoimmunity. Previously, a classical latency period of several weeks was accepted for post-vaccination events, similarly to the time frame suggested for post-infectious autoimmunity (i.e. rheumatic fever). However, substantial evidence for a longer latency period (i.e. several months to years) between infection, vaccination or silicone breast implants and autoimmune phenomena has been also described.

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