Multi system granulomatous injuries 28 years after paraffin injections

Non-parathyroid hypercalcemia associated with paraffin oil injection in 12 younger male bodybuilders: a case series

“…Short-term complications associated with injection of paraffin oil include inflammation, ulceration and skin necrosis (11). Potential long-term adverse effects to injections with paraffin oil was reported by Albitar et al in a 63-year-old man who had paraffinomas associated with severe hypercalcemia, renal failure, oil pneumonia and granulomatous skin lesions (10). Gyldenløve et al found severe hypercalcemia (P-Ca 2+ 2.29 mmol/L) with low levels of PTH and 25-hydroxyvitamin D, renal insufficiency, nephrocalcinosis and elevated levels of angiotensinconverting enzyme, interleukin receptor and calcitriol in a 23-year-old bodybuilder who had injected himself with paraffin oil (8).…”

“…In recent years, a few case reports have been published on non-parathyroid hypercalcemia attributable to use of various body fillers for cosmetic purposes, including subcutaneous injections with silicone and ruptures of silicone implants, as well as injection of methylmethacrylate and mineral/organic oil (3,4,5,6,7). In three case reports, non-parathyroid hypercalcemia have been reported in bodybuilders who have used intramuscular injections of paraffin oil to augment muscle size (8,9,10). Biopsies from areas injected with body fillers have suggested a foreign body reaction with granuloma formation expressing 1α-hydroxylase activity, suggesting that the hypercalcemia is attributable to an increased calcitriol synthesis, which may cause intestinal hyperabsorption of calcium resulting in hypercalcemia.…”

Rare Causes of Hypercalcemia

“…Hypercalcemia complicated pericarditis caused by Nocardia asteroides in a patient with hypoparathyroidism (59). It complicated the management of a 63-yr-old male with multiorgan failure histologically associated with the presence of widespread granulomatous lesions associated with paraffin 28 yr after a paraffin mammoplasty (60). Finally, serum calcium levels adjusted for serum albumin were found to be slightly higher in a large group of patients with brucellosis than in a control group, although the differences were small, and additional investigation of mechanisms were not performed (61).…”

Hypercalcemia Associated with Local and Ectopic Hormone Production

“…58 Foreign bodies that cause a granulomatous reaction leading to hypercalcemia include talc, 59 silicone, 60 beryllium, 61 and paraffin. 62 Additionally, intravesicle Bacillus Calmette-Guérin (BCG) immunotherapy for bladder cancer was reported to cause granulomatous hepatitis and hypercalcemia. 63 Another agent used to treat advanced solid malignancies, 8-chloro-cAMP, was also reported to cause 1,25(OH) 2 D-mediated hypercalcemia, but no clear granulomatous reaction was identified.…”