This report describes a case of adult respiratory distress syndrome (ARDS) after massive subcutaneous injections of silicone. The patient, a 23 year-old transsexual man, treated with mechanical ventilation, died on the 12th day of hospital, in septic shock and refractory hypoxemia. Autopsy findings revealed empty vacuoles surrounded by macrophages in various organs, especially in lung tissue. Toxicological analysis by emission by high frequency induced plasma showed silicone in the organs with histological lesions. The pathophysiology of this ARDS is considered.