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

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.