Hypercalcemia secondary to granulomatous disease caused by the injection of methacrylate: a case series

Abstract

SummaryAssociation of dysregulated calcium homeostasis and granulomatous disease is well established. There exist reports in the literature of granulomatous reactions produced by silicones associated with hypercalcemia. In this case series we report four young women that underwent methacrylate injections in gluteus, thighs and calves that developed granulomas with posterior appearance of hypercalcemia. This complication presented as subacute around 6 months after the procedure. The four patients have as common elements the presence of moderate to severe renal insufficiency, suppressed PTH and elevated calcitriol levels for the degree of renal function. In the image studies, two patients presented in the nuclear magnetic resonance of the gluteus hypodense nodular images compatible with granulomas. Two patients had a positron emission tomography performed showing increased metabolic activity in the muscles of the gluteal region compatible with granulomas. Two patients had a partial surgical resection of the gluteal lesions with the finding of methacrylate associated to foreign body granulomas. In these patients hypercalcemia was treated with oral or local injections of corticoids, intravenous bisphosphonates or ketoconazole with good response. Although the prevalence of this complication with methacrylate injection is not common, hypercalcemia secondary to granulomas should be considered in the differential diagnosis of patients with hypercalcemia when there is a history of this procedure, and especially if they have a reduction in their renal function.

An unexpected cause of severe and refractory PTH-independent hypercalcemia: case report and literature review

“…All patients had severe hypercalcemia, low or suppressed PTH levels, and high or inappropriately normal serum calcitriol levels (9).…”

Silicone Granulomatous Inflammation Resulting in Hypercalcemia: A Review of the Literature

“…It has been seen that hypercalcemia once controlled could recur and lead to renal failure. This has been the most common complication reported, with possible dialysis dependence (19). A systematic review by Tachamo et al (10) found two reported cases of deaths.…”

“…Two deaths occurred and 2 other patients had unsuccessful surgical attempts. The remaining 19 (82.6%) cases were medically treated (19). Granulomatous disease should be considered in the differential diagnosis of patients with prior cosmetic procedures who present with non-PTH-mediated hypercalcemia.…”

A Case of Hypercalcemia and Overexpression of CYP27B1 in Skeletal Muscle Lesions in a Patient with HIV Infection After Cosmetic Injections with Polymethylmethacrylate (PMMA) for Wasting

“…The first report of hypercalcemia related to PMMA-induced granuloma emerged in 2014, with a series of four women [10] (Table 1). While it is presumed that the hypercalcemia from foreign body-induced granuloma is due to increased CYP27B1 activity in activated macrophages (as in sarcoidosis), evidence to confirm this is limited and has not been previously demonstrated with PMMA.…”