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Neubauer C, Gebler O, Wilpert C, Scherwitz M, Efinger N, Bamberg F, Windfuhr-Blum M, Neubauer J. Photon-counting CT of degenerative changes and rupture of silicone breast implants: a pilot study. Eur Radiol Exp 2024; 8:36. [PMID: 38480588 PMCID: PMC10937890 DOI: 10.1186/s41747-024-00434-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/11/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Accurate assessment of breast implants is important for appropriate clinical management. We evaluated silicone properties and diagnostic accuracy for characterizing silicone implants and detecting degenerative changes including rupture in photon-counting computed tomography (PCCT). METHODS Over 16 months, we prospectively included patients with silicone implants and available breast magnetic resonance imaging (MRI) who received thoracic PCCT performed in prone position. Consensus reading of all available imaging studies including MRI served as reference standard. Two readers evaluated all implants in PCCT reconstructions for degenerative changes. In a subgroup of implants, mean density of silicone, adjacent muscle, and fat were measured on PCCT reconstructions. Contrast-to-noise ratios (CNRs) were calculated for implant-to-muscle and implant-to-fat. RESULTS Among 21 subjects, aged 60 ± 13.1 years (mean ± standard deviation) with 29 implants PCCT showed the following: high accuracy for linguine sign, intraimplant fluid (all > 0.99), peri-implant silicone (0.95), keyhole sign (0.90), and folds of the membrane (0.81); high specificity for linguine sign, intraimplant fluid, keyhole sign, folds of the membrane (all > 0.99), and peri-implant silicone (0.98); and high sensitivity for linguine sign and intraimplant fluid (all > 0.99). In a subgroup of 12 implants, the highest CNR for implant-to-muscle was observed on virtual unenhanced reconstructions (20.9) and iodine maps (22.9), for implant-to-fat on iodine maps (27.7) and monoenergetic reconstructions (31.8). CONCLUSIONS Our findings demonstrate that silicone breast implants exhibit distinct contrast properties at PCCT, which may provide incremental information for detection of degenerative changes and rupture of implants. RELEVANCE STATEMENT Thoracic photon-counting computed tomography is a promising modality for the diagnostic assessment of silicone breast implants. KEY POINTS • Thoracic photon-counting computed tomography demonstrates unique contrast properties of silicone breast implants. • Iodine map reconstructions reveal strong contrast-to-noise ratios for implant-to-muscle and implant-to-fat. • Thoracic photon-counting computed tomography shows high diagnostic accuracy in detecting implant degeneration and rupture. TRIAL REGISTRATION German Clinical Trials Register number DRKS00028997, date of registration 2022-08-08, retrospectively registered.
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Affiliation(s)
- Claudia Neubauer
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Oliver Gebler
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Caroline Wilpert
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maxim Scherwitz
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Niklas Efinger
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marisa Windfuhr-Blum
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakob Neubauer
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Simon E, Pahus L, Chanez P. Pulmonary adverse events of breast silicone implants and silicone injection. Respir Med Res 2023; 84:101065. [PMID: 38042060 DOI: 10.1016/j.resmer.2023.101065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/24/2023] [Accepted: 10/31/2023] [Indexed: 12/04/2023]
Abstract
The incidence of breast implants and silicone injections has continuously increased since their FDA approval for use in the 1960's. The prevalence of overall adverse events is approximately 20%. The actual incidence of pulmonary adverse events is unknown. This review focuses on the pulmonary adverse events of breast implants and silicone injections. Vascular complications are represented by acute and chronic embolisation syndromes with a clinico-radiological presentation of alveolar hemorrhage. Inflammatory complications are numerous, including siliconoma, which is a granulomatous reaction mimicking a mesothelioma. On the other hand, there are some reports arguing a link between the development of auto-immune diseases and breast implants, such as scleroderma, rheumatoid arthritis, Sjögren's syndrome, and dermatomyositis. Finally, for patients with asthma, breast implants may contribute to poor disease control. Cases of eosinophilic granulomatosis with polyangeitis have been described. Thus, it is of interest to decipherate mechanisms and incidence of these effects in prospective studies to better manage pulmonary diseases in patients wearing breast implants in order to understand their role as culprits or bystanders. In addition, characterization of subpopulations with increased risk of adverse events is needed as we highlighted that some subpopulations seem to be at greater risk of developing them, notably asthmatics.
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Affiliation(s)
- Eléonore Simon
- APHM, Clinique des bronches allergies et sommeil, Marseille, France.
| | - Laurie Pahus
- Aix Marseille Univ, APHM, INSERM CIC 1409 Marseille, France; Aix Marseille Univ, INSERM U1263, INRA 1260 (C2VN), Marseille, France
| | - Pascal Chanez
- APHM, Clinique des bronches allergies et sommeil, Marseille, France; Aix Marseille Univ, INSERM U1263, INRA 1260 (C2VN), Marseille, France
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3
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Montemurro P, Pellegatta T, Burton H, Pafitanis G. Silicone Migration From Breast Implants: A Case of Ocular Siliconoma and Literature Review. Aesthet Surg J 2023; 43:972-977. [PMID: 36991214 DOI: 10.1093/asj/sjad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Breast augmentation with implants is one of the most popular cosmetic surgery operations performed worldwide. Complications of breast implants are well recognized, and include capsular contracture, implant rupture, and infrequently distant migration of silicone, resulting in siliconoma. Distant migration of silicone can present many years after implantation with a wide variety of signs and symptoms. OBJECTIVES The aim of this study was to describe the authors' experience of orbital silicone migration and to review the literature describing documented cases of distant silicon migration from breast implants, both ocular and nonocular. METHODS In January 2022, a case of breast implant augmentation presented with silicone migration into the right orbit. This rare case was monitored and diagnosed with ocular muscle palsy and diplopia. Here, the authors present the patient's presenting complaint, symptomatology, working investigations, and outcomes. A comprehensive report of all available cases of distant silicone migration is presented along with their associated complications and more specifically ocular silicone migration. RESULTS Systemic migration of silicone from breast implants to the orbital region is extremely rare: a total of 4 previous cases of ocular silicone migration from breast implants have been described previously; the authors describe the fifth case herein. CONCLUSIONS Silicone implant rupture can present with a wide variety of clinical symptoms that may mimic different clinical pathologies. In every patient with a history of breast augmentation with silicone implants, the possibility of silicone migration should be always taken into consideration during the differential diagnosis process. LEVEL OF EVIDENCE: 5
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Autoimmune/autoinflammatory syndrome induced by adjuvants: a focus on silicone. Clin Rheumatol 2022; 41:3275-3283. [PMID: 35798923 DOI: 10.1007/s10067-022-06274-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/30/2022] [Accepted: 06/29/2022] [Indexed: 11/03/2022]
Abstract
Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) was first described in 2011 to cover disorders characterized by dysregulation of the immune system after exposure to an adjuvant. In the present review, the authors focus on silicone-induced ASIA. In the last two decades, there has been worldwide increase in the use of silicone breast implant (SBI) as an aesthetic procedure, raising concerns for possible effects on the immune system, especially in people who already have previous immune dysregulation. The authors did a critical review of the most important articles referring to silicone-induced ASIA, including most recent studies regarding physiopathologic mechanism. Despite large-scale epidemiological studies conducted to assess the association between SBI and autoimmune/rheumatic disorders, the results remain inconclusive, and the debate over the safety of SBIs remains heated. The explantation of silicone breast has been indicated for silicone-induced ASIA with improvement of unspecific symptoms in the majority of patients; however, the outcome seems different in patients with definitive autoimmune rheumatic disease (AIRD). There is no prospective study evaluating the risk of flares after SBI in patients who already have an AIRD. Therefore, based on the literature, we cannot contraindicate the procedure; however, we need to advertise about the risk of ASIA to the patients with AIRD. Long-term safety and implant-related outcomes should be discussed with these patients, considering each case individually, assessing genetic and environmental factors, and determining if the autoimmune disease is in remission or not, for shared decision among patient and the physician.
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Khakbaz E, Lang C, Lelkaitis G, Grønhøj C. Late migration of silicon as a complication to breast transplant rupture: Case report and literature review. Int J Surg Case Rep 2021; 85:106241. [PMID: 34333256 PMCID: PMC8346674 DOI: 10.1016/j.ijscr.2021.106241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/24/2022] Open
Abstract
Silicone implants have been used for breast augmentations, both cosmetically and in reconstructive surgery since the 1960s. Rupture of breast implants and silicone migration is a well-known complication. In this case report and literature review, we present a case of a 53-year-old woman with bilateral cosmetic silicone gel breast implant in 1986, and a replacement with saline gel in 2005. The patient had no breast complaints and observed no change in breast volume during this period. In 2020, silicone was randomly identified in a right-sided cervical lymph node in an attempt to remove suspicious lymphadenopathy. The source of the silicone is still doubted; that is, it is not known if the silicone originated from the saline implant or the silicone gel implant. In our literature review, we find that distant migration of silicone and lymphadenopathy have occurred for silicone breast implants although very rare for saline gel breast implants. A case of cervical lymphadenopathy caused by silicone breast migration is described. The patient had primarily long-standing silicone gel breast implant and has saline breast implant afterwards. The origin of the silicone conglomerate in the cervical lymph node remains unknown.
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Affiliation(s)
- Elham Khakbaz
- Department of Head and Neck Surgery, Rigshospitalet, Denmark
| | - Christian Lang
- Department of Plastic Surgery, Herlev University Hospital, Denmark
| | | | - Christian Grønhøj
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.
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Colbenson GA, Dempsey TM, Cecchini MJ, Aubry MC, Moua T, Ryu JH. A Bodybuilder with Dyspnea and Hypercalcemia. Am J Med 2021; 134:e363-e365. [PMID: 33316251 DOI: 10.1016/j.amjmed.2020.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Matthew J Cecchini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | | | - Teng Moua
- Division of Pulmonary and Critical Care Medicine
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine
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Bonfirraro PP, Sallam D, Verga M, Righi B, Mevio G, Codazzi D, Leone F, Carminati M. A Rare Case of Pulmonary Restrictive Syndrome after Liquid Silicone Injection: The Role of the Plastic Surgeon. Indian J Plast Surg 2021; 54:90-93. [PMID: 33814749 PMCID: PMC8012792 DOI: 10.1055/s-0040-1721862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Despite being especially used in its solid form, silicone is still injected as a liquid filler for breast contouring in many countries. Here, we present a rare case of a woman with silicone pneumonitis and extended breast scarring after breast silicone injection. Because of evidence of a restrictive syndrome due to the thoracic extensive scarring tissue and the high demand of oxygen therapy, as jointly agreed with the pulmonologists, we decided to perform a surgical asportation of the scarring tissue and covering with microsurgical flap. We chose the deep inferior epigastric perforator flap mainly because of the large amount of skin that is possible to use, the good skin texture matching, and the possibility of double team working without changing patient’s position.
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Affiliation(s)
- Pier Paolo Bonfirraro
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Davide Sallam
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maurizio Verga
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Bernardo Righi
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gabriele Mevio
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Denis Codazzi
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Leone
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marcello Carminati
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
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Not All That Shines on a PET Scan Is Cancer: A Silicone-Induced Granuloma Masquerading as Malignancy. Clin Pract 2020; 11:8-12. [PMID: 33599216 PMCID: PMC7774518 DOI: 10.3390/clinpract11010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022] Open
Abstract
PET/CT scans are frequently used in the initial workup of suspicious lesions but not all that lights up on a PET is cancerous. We wish to discuss a case of silicone-induced granuloma mimicking malignancy and the role of other imaging modalities for further workup.
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9
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Free Silicone Injections to the Breast: Delayed Complications and Surgical Management of Sequelae. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3208. [PMID: 33299689 PMCID: PMC7722574 DOI: 10.1097/gox.0000000000003208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/01/2020] [Indexed: 11/26/2022]
Abstract
This case describes a healthy 37-year-old woman who presented with bilateral breast pain and nodules years after receiving free silicone injections to her breasts. Mammogram revealed extremely dense breasts with innumerable bilateral masses of various sizes. Ultrasound was non-diagnostic due to poor penetration and artifact from silicone. Histologic examination revealed vacuolated histiocytes and innumerable cystic spaces containing material consistent with silicone. Patient underwent bilateral nipple-sparing mastectomy with immediate reconstruction using tissue expanders. This case highlights the potential for serious complications developing years after free silicone injections as well as our team’s surgical management of these complications.
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10
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Saha BK, Najmuddin M. A 63-Year Old Woman with a History of Hodgkin's Lymphoma and Incidentally Identified Bilateral Axillary Lymphadenopathy. Am J Med Sci 2020; 361:e35-e36. [PMID: 33250157 DOI: 10.1016/j.amjms.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/02/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Biplab K Saha
- Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, Missouri, USA.
| | - Mufaddal Najmuddin
- Division of Pathology, Ozarks Medical Center, West Plains, Missouri, USA
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11
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Li SJ, Kam NM, Mehta K, Sutherland TR. Enlarging internal mammary silicone lymphadenopathy mimicking breast metastases. J Med Imaging Radiat Oncol 2020; 65:216-218. [PMID: 33179438 DOI: 10.1111/1754-9485.13124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Simon J Li
- Medical Imaging Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Ning Mao Kam
- Medical Imaging Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Kirti Mehta
- Medical Imaging Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,BreastScreen, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Tom R Sutherland
- Medical Imaging Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Gavoille A, Vincent M, Kiakouama L, Catinon M, Lamkhioued M, Devouassoux M, Grumet P, Jamilloux Y, Sève P. Sarcoidosis after breast implant rupture: Looking beyond granulomas. Autoimmun Rev 2020; 19:102673. [PMID: 32942033 DOI: 10.1016/j.autrev.2020.102673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Antoine Gavoille
- Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69004 Lyon, France
| | - Michel Vincent
- Minapath Developpement, Insavalor CS, 52132 Villeurbanne, France
| | - Lize Kiakouama
- Department of Pneumology, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69004 Lyon, France
| | - Mikael Catinon
- Minapath Developpement, Insavalor CS, 52132 Villeurbanne, France
| | - Medhi Lamkhioued
- Department of Pneumology, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69004 Lyon, France
| | - Mojgan Devouassoux
- Laboratory of Pathology, Hôpital de la Croix Rousse, Hospices Civils de Lyon, F-69004 Lyon, France
| | - Pierre Grumet
- Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69004 Lyon, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69004 Lyon, France
| | - Pascal Sève
- Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69004 Lyon, France.
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Yedla N, Perez E, Lagari V, Ayala A. SILICONE GRANULOMATOUS INFLAMMATION RESULTING IN HYPERCALCEMIA: A REVIEW OF THE LITERATURE. AACE Clin Case Rep 2018; 5:e119-e123. [PMID: 31967015 DOI: 10.4158/accr-2018-0277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/14/2018] [Indexed: 11/15/2022] Open
Abstract
Objective Silicone usage for cosmetic enhancement is common, although it is not approved by the U.S. Food and Drug Administration. Granulomatous inflammation leading to hypercalcemia is a rare complication. We present a case of non-parathyroid hormone (PTH), calcitriol-mediated hypercalcemia in a woman with a history of cosmetic injections. Methods Case report and review of the literature. Results A 48-year-old female with metabolic syndrome was evaluated for severe hypercalcemia (calcium >15 mg/dL). Laboratory tests revealed low-normal PTH, normal 25-hydroxyvitamin D, elevated 1,25-dihydroxyvitamin D, and hypercalciuria. Imaging studies, including a computed tomography (CT) scan of the lungs, was nonrevealing. Positron emission tomography/CT showed symmetric hypermetabolic subcutaneous stranding of bilateral gluteus and proximal thighs. She admitted to silicone injections in the buttocks 10 years prior. Her examination was unremarkable except for an intermittent pruritic rash over the right thigh. Labs revealed total serum calcium 11.3 mg/dL, PTH 18 pg/mL, 24-hour urinary calcium 509 mg, and PTH-related peptide 18 pg/mL. Serum and urine electrophoresis were normal, 25-hydroxyvitamin D was 47 pg/mL, and 1,25-dihydroxyvitamin D was 121 pg/mL. Angiotensin-converting enzyme level was 80 U/mL. A diagnosis of granulomatous inflammation resulting in calcitriol-mediated, PTH-independent hypercalcemia was entertained. Conclusion Silicone-induced hypercalcemia should be thought of in those with prior cosmetic injections. Tissue biopsy confirms the diagnosis, which is often delayed. We reviewed 19 cases with silicone usage and variable levels of hypercalcemia. Renal injury was common. One death was reported. Glucocorticoids, calcium restriction, and hydration have been used to treat calcitriol-mediated hypercalcemia but are not curative. Ketoconazole and bisphosphonates have been used with variable success. Surgical excision tends to be ineffective due to silicone migration. The treatment of this disorder is difficult and often ineffective.
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