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

Abstract

Objective: Silicone usage for cosmetic enhancement is common, although it is not approved by the U.S. Food and Drug Administration. Granulomatous inflammation leading to hypercalcemia is a rare complication. We present a case of non-parathyroid hormone (PTH), calcitriolmediated hypercalcemia in a woman with a history of cosmetic injections. Methods: Case report and review of the literature. Results: A 48-year-old female with metabolic syndrome was evaluated for severe hypercalcemia (calcium >15 mg/dL). Laboratory tests revealed low-normal PTH, normal 25-hydroxyvitamin D, elevated 1,25-dihydroxyvitamin D, and hypercalciuria. Imaging studies, including a computed tomography (CT) scan of the lungs, was nonrevealing. Positron emission tomography/CT showed symmetric hypermetabolic subcutaneous stranding of bilateral gluteus and proximal thighs. She admitted to silicone injections in the buttocks 10 years prior. Her examination was unremarkable except for an intermittent pruritic rash over the right thigh. Labs revealed total serum calcium 11.3 mg/dL, PTH 18 pg/mL, 24-hour urinary calcium 509 mg, and PTH-related peptide 18 pg/mL. Serum and urine electrophoresis were normal, 25-hydroxyvitamin

Silicone injection-induced granuloma formation, hypercalcemia and nephrolithiasis: a case report

“… 1 Moreover, it is hypothesized that a T-cell mediated reaction triggered by silicone, adulterants, infection, or even trauma may activate macrophages and trigger release of cytokines such as TNF-α, IL-1, and IL-6. 1 , 2 In our patient, delayed follow-up revealed worsening hypercalcemia, hypoparathyroidism, depressed plasma calcidiol, and relatively increased plasma calcitriol, consistent with those seen in granulomatous diseases with preserved renal function. 3 , 4 …”

Case Series: Hypercalcemia From Granulomatous Silicosis Developing After COVID-19 Infection

“… 12 Reports have described silicone granulomas responding well to minocycline and doxycycline due to their immunomodulatory properties. 13 Methotrexate may also be used to treat inflammation caused by silicosis via increased release of adenosine and immunosuppression through apoptosis and clonal deletion of T-cells. 13 Long-term outcomes documented in these patients range from complete remission with steroids, to overt renal failure due to long-term elevated calcium levels.…”

Siliconoma successfully controlled with low-dose oral isotretinoin: A case report with histopathologic and ultrasonographic findings

“… 6 Other severe complications of LIS include acute pneumonitis, 2 granulomatous hepatitis, 2 and hypercalcemia associated with siliconoma. 7 Inflammation can occur months to years after injection. Some theories have been proposed to explain LIS-induced inflammation, including immunologic viral cross-reactivity and acute and/or chronic inflammation due to silicone impurity.…”