title: Calcitriol mediated hypercalcaemia with silicone granulomas due to cosmetic injection.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Reading Hospital and Medical Center, Reading, Pennsylvania, USA.|Lebanon, Pennsylvania, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Melnick
authors.affiliation: Reading Health System, Reading, Pennsylvania, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Abaroa-Salvatierra
authors.affiliation: Department of Internal Medicine, Reading Health System, Reading, Pennsylvania, USA.
authors.forename: Mrunalini
authors.initials: M
authors.lastname: Deshmukh
authors.affiliation: Reading Health System, Reading, Pennsylvania, USA.
authors.forename: Arti
authors.initials: A
authors.lastname: Patel
mesh_terms: D000328:Adult; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D002117:Calcitriol / Q000009:adverse effects*; D005260:Female; D015745:Granuloma, Foreign-Body / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000139:chemically induced* / Q000150:complications; D007267:Injections; D012826:Silicone Elastomers / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D050071:Bone Density Conservation Agents; D012826:Silicone Elastomers; D002117:Calcitriol