Silicone-Induced Granulomatous Reaction Causing Severe Hypercalcemia: Case Report and Literature Review

Abstract

A 67-year-old woman presented to the hospital with complaints of abdominal pain. Physical exam was significant for signs of severe dehydration, mild epigastric tenderness and multiple non-tender hard nodules over her arms and thighs. Incidental finding of severe hypercalcemia led to negative workups for hyperparathyroidism, vitamin D intoxication, and malignancy. However, elevated levels of 1,25-hydroxy vitamin D raised the possibility of granulomatous diseases. Imaging and patient report revealed silicone-induced foreign body granulomatous reaction as the cause of hypercalcemia. Use of silicone for cosmetic enhancement of body contours can result in siliconomas, severe hypercalcemia, and complications. Treatment is unestablished for this condition. Increasing prevalence of cosmetic enhancement should prompt vigilance for this rare disease entity. Providers should counsel and educate individuals undergoing such procedures.

56-Year-Old Woman Presenting With Fatigue, Weakness, and Malaise

“…Reported complications from silicone injections include cellulitis, abscess formation, ulceration, scarring, migration, and granuloma formation. [5][6][7][8][9] Review of the current literature revealed primarily case reports of silicone granulomas. [5][6][7][8][9] A systematic review of multiple case reports identified the most common cause (silicone), site affected (buttock), treatment (hydration, corticosteroids, and bisphosphonates), and complication (renal failure) in patients with hypercalcemia associated with cosmetic injections.…”

“…However, not all patients respond to corticosteroid use, and long-term corticosteroid use is associated with significant morbidity. [5][6][7][8][9] Immunosuppressant medications, such as hydroxychloroquine and etanercept, have been used in cases of silicone-induced granulomas as well as in hypercalcemia secondary to sarcoidosis. They are used for their anti-inflammatory effects, but they are more so used if corticosteroid therapy failed or led to intolerable adverse effects or following a corticosteroid taper.…”

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

“…At the same time, immunohistochemical studies have demonstrated activated 1-α hydroxylase in macrophages of sarcoid and foreign-body granulomas, suggesting that silicone-induced hypercalcemia may in part be regulated by calcitriol. 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.…”

“… 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 …”

Ratlarda gecikmiş testis torsiyon modelinde subkapsüler orşiyektomi sonrası protez olarak bone-wax implantasyonunun sonuçları

“…Proteze bitişik bölgelerde fibröz kapsül oluşumu ve yabancı cisim reaksiyonu, uzun takiplerde, silikon partiküllerinin bölgesel, nadiren de paraaortik lenf düğümlerine ve solid organlara migrasyonuna ikincil olarak granülomatöz hepatit, hiperkalsemi ve splenomegali bildirilmiştir. [9][10][11][12][13] Daniel ve ark., metastatik prostat adenokarsinomlu 10 hastaya subkapsüler orşiyektomi yapmış ve silikon protezi subkapsüler olarak başarıyla implante etmiş, sadece bir olguda minimal skrotal ödem rapor etmiştir. [14] Bununla birlikte, silikon protez kılıfın yırtılması sonucu silikon kaçağı ve buna bağlı granülomatöz reaksiyon nedeniyle inflamasyon ve ağrı oluşabilir.…”