title: Hypercalcemia secondary to granulomatous disease caused by the injection of methacrylate: a case series.
abstract: Association 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.
authors.affiliation: Instituto de Investigaciones Metabólicas, Universidad del Salvador, Buenos Aires, Argentina.
authors.forename: Armando Luis
authors.initials: AL
authors.lastname: Negri
authors.affiliation: Servicio de Nefrología, Hospital Italiano de Buenos Aires, Argentina.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Rosa Diez
authors.affiliation: Instituto de Investigaciones Metabólicas, Universidad del Salvador, Buenos Aires, Argentina.
authors.forename: Elisa
authors.initials: E
authors.lastname: Del Valle
authors.affiliation: Hospital Español de Mendoza, Argentina.
authors.forename: Elsa
authors.initials: E
authors.lastname: Piulats
authors.affiliation: Servicio de Nefrología, Hospital Italiano de Buenos Aires, Argentina.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Greloni
authors.affiliation: Servicio de Nefrología, Hospital Fernández, Buenos Aires, Argentina.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Quevedo
authors.affiliation: Servicio de Nefrología, Hospital Italiano de Buenos Aires, Argentina.
authors.forename: Federico
authors.initials: F
authors.lastname: Varela
authors.affiliation: Servicio de Endocrinología, Hospital Italiano de Buenos Aires, Argentina.
authors.forename: Maria
authors.initials: M
authors.lastname: Diehl
authors.affiliation: Servicio de Nefrología, Hospital Alemán, Buenos Aires, Argentina.
authors.forename: Pablo
authors.initials: P
authors.lastname: Bevione
keywords: granulomatous disease; hypercalcemia; methacrylate