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CASE REPORT
Calcitriol mediated hypercalcaemia with silicone granulomas due to cosmetic injection
  1. Stephen Melnick1,2,
  2. Ana Abaroa-Salvatierra3,
  3. Mrunalini Deshmukh4,
  4. Arti Patel3
  1. 1Department of Internal Medicine, Reading Hospital and Medical Center, Reading, Pennsylvania, USA
  2. 2Lebanon, Pennsylvania, USA
  3. 3Reading Health System, Reading, Pennsylvania, USA
  4. 4Department of Internal Medicine, Reading Health System, Reading, Pennsylvania, USA
  1. Correspondence to Dr Stephen Melnick, stmelnick{at}gmail.com

Summary

We present a case of a 41-year-old woman with medical history significant for urolithiasis presenting to our hospital for psychiatric evaluation due to worsening depression and suicidal ideations for the past 2 weeks. Initial laboratory results show hypercalcaemia of 13.5 mg/mL that led to consulting internal medicine. On further questioning, the patient admitted to cosmetic silicone injections in her buttocks which were causing calcium deposition under her skin, leading to disfigurement of the sacrum and lumbar regions. She underwent further evaluation with CT and laboratory testing, which effectively ruled out malignancy and primary hyperparathyroidism. The hypercalcaemia was diagnosed as non-PTH-dependent with high levels of 1,25-dihydroxyvitamin D and low PTH. She eventually underwent tissue biopsy confirming the presence of silicone granulomas responsible for the calcitriol-mediated hypercalcaemia. This case reminds one to keep a broad differential especially in patients with hypercalcaemia in which malignancy and primary hyperparathyroidism have been ruled out.

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Footnotes

  • Contributors SM wrote the majority of the manuscript. AA-S was involved in writing the manuscript and editing. MD was involved in following the patient and helping to edit the manuscript. AP was also involved in patient care and editing the manuscript. Moreover, all authors were involved in proofreading and revision. SM is the study guarantor. All the authors significantly contributed to the development of this manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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