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Hindi SM, Wang Y, Jones KD, Nussbaum JC, Chang Y, Masharani U, Bikle D, Shoback DM, Hsiao EC. A Case of Hypercalcemia and Overexpression of CYP27B1 in Skeletal Muscle Lesions in a Patient with HIV Infection After Cosmetic Injections with Polymethylmethacrylate (PMMA) for Wasting. Calcif Tissue Int 2015; 97:634-9. [PMID: 26253396 PMCID: PMC4861400 DOI: 10.1007/s00223-015-0048-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Abstract
Foreign body-induced granuloma is an uncommon yet clinically significant cause of hypercalcemia. The molecular mechanisms are uncertain, although extrarenal calcitriol production has been proposed. We describe severe hypercalcemia associated with increased levels of plasma calcitriol in a patient with HIV and local granulomatous reaction 5 years after injection of polymethylmethacrylate (PMMA) as dermal filler for cosmetic body sculpting. Extensive evaluation revealed no identifiable cause of increased calcitriol levels. Nuclear imaging was remarkable for diffuse uptake in the subcutaneous tissues of the buttocks. Subsequent muscle biopsy and immunohistochemical staining showed strong local expression of CYP27B1 within histiocytes surrounding globules of PMMA. This case highlights an unfortunate complication of dermal fillers and shows that inflammatory cells can express high levels of CYP27B1 even without frank granulomas. The growing trend of body contour enhancement using injectable fillers should raise suspicion for this cause of hypercalcemia in clinical practice. Patients with HIV who receive this treatment for lipodystrophy or other cosmetic purposes may have increased susceptibility to hypercalcemia in the setting of underlying chronic inflammation. This may be a concern when changing anti-retroviral therapy, since alterations in levels of HIV viremia may initiate or contribute to worsening hypercalcemia.
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Affiliation(s)
- Sahar M Hindi
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California, San Francisco, 513 Parnassus Ave, HSE901G, UCSF Box 0794, San Francisco, CA, 94143-0794, USA
| | - Yongmei Wang
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, and the Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kirk D Jones
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Jesse C Nussbaum
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Yongen Chang
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Umesh Masharani
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California, San Francisco, 513 Parnassus Ave, HSE901G, UCSF Box 0794, San Francisco, CA, 94143-0794, USA
| | - Daniel Bikle
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, and the Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Dolores M Shoback
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, and the Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Edward C Hsiao
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California, San Francisco, 513 Parnassus Ave, HSE901G, UCSF Box 0794, San Francisco, CA, 94143-0794, USA.
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA.
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