A CASE OF HYPERCALCEMIA AFTER AESTHETIC PROCEDURE

Résumé fourni par la source

Polymethyl methacrylate (PMMA) is a non-degradable synthetic polymer. This semi-permanent dermal filler is approved only for minimally invasive procedures. However, injection of PMM in large quantities for cosmetic purposes of filling into other parts of the body is non-approved by the United States Food and Drug Administration, including the gluteal region and thighs. PMMA injections may cause the formation of foreign body granulomas that lead to severe hypercalcemia, nephrolithiasis, acute and chronic kidney disease, and possibly death. Here, we report a case of a 35-year-old woman was admitted to the Emergency Room in April 2024 with a history of nausea, vomiting, anorexia, polyuria, polydipsia, and constipation that had started 4 weeks ago. Admission tests showed creatinine 2.9 mg/dl, urea 53 mg/dl, total calcium 12.5 mg/dl (normal range: 8.6-10), ionizable calcium 1.58 mmol/L (normal range 1.15-1.35), mild normochromic and normocytic anemia. She presented with dry mucous membranes and normal hemodynamic status. She reported a previous hospitalization with the same symptoms three months ago, also associated with hypercalcemia and kidney dysfunction. She was advised to continue outpatient follow-up for investigation, but did not return. Tests during the current hospitalization revealed 25-hydroxyvitamin D 26.8 ng/ml, 1,25-dihydroxyvitamin D = 88.80 pg/ml (normal range: 19.9 -79.3), parathyroid hormone 18 pg/ml (normal range: 10-60). Protein electrophoresis, serum and urine immunofixation were negative for monoclonal components. During investigation, abdominal tomography revealed hypodense images in subcutaneous cellular tissue of both buttocks. When asked about the findings, the patient reported that in December 2022, she received polymethyl methacrylate (PMMA) injections in the buttocks and thighs for aesthetic purposes. Positron emission tomographic images were acquired in conjunction with low-dose multislice computed tomography (PET/CT) revealed multiple nodular formations in the subcutaneous tissue in the gluteal region and thighs bilaterally, of varying sizes, with increased metabolism. The patient in this case was treated with intravenous hydration using 0.9% saline solution, furosemide and methyl-prednisolone, with reversal of symptoms and normalization of calcemia and kidney function. She was discharged from hospital using hydroxychloroquine 400 mg/day. Her laboratory tests remained normal in an evaluation performed 3 months after discharge.

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