FRI695 Hypercalcemia Mediated By Granulomatous Disease Due To Polymethylmethacrylate (pmma) Injection Utilization For Gluteal Augmentation

Abstract

Abstract Disclosure: T. Mishra: None. J. Craven: None. Introduction: While etiologies for hypercalcemia commonly include hyperparathyroidism, malignancy or vitamin D intoxication, unusual causes should also be considered. We present a case that describes a patient who presented with hypercalcemia in the setting of granulomatous reaction to PMMA filler for gluteal augmentation. Clinical case: A 52 year old female with a past medical history of hypertension, stage III chronic kidney disease, nephrolithiasis, depression was admitted to the hospital with a peak calcium of 15.8 mg/dl (n: 8.4-10.4mg/dl). Hypercalcemia was incidentally noted while she was undergoing workup for her chronic kidney disease. Initial testing revealed PTH of 22 pg/ml (n: 22-94). 25 hydroxy vitamin D 24ng/ml, (n: 30-80), 1, 25 dihydroxy D2 markedly elevated at 258 pg/ml (n: 19-79). SPEP/UPEP normal. PTHrp was found to be 5.9 pmol/L(n: 0-3.4pmol/L). High-resolution CT chest did not show evidence of granulomatous disease or lung masses. A PET scan was obtained which showed extensive hypermetabolic activity in the bilateral gluteus medius and maximus muscle consistent with her history of PMMA injection for buttock augmentation. She was placed on aggressive maintenance intravenous fluid hydration. In addition, Lasix, zoledronic acid and calcitonin were administered. With these measures her calcium improved to a level of 10.7mg/dl. She did not tolerate high dose glucocorticoids. With her treatment intolerance and progressive renal disease in mind, plastic surgery has been consulted to explore surgical options for PMMA debulking. Conclusion: This represents a case of hypercalcemia mediated by elevated levels of calcitriol due to granulomatous inflammation caused by a foreign body reaction to PMMA injection. Polymethylmethacrylate is primarily used in South/Central America as a synthetic filling agent in cosmetic procedures, but is not FDA approved for gluteal injection. To our knowledge, there is only one other case report of MMA mediated hypercalcemia in the US. Given the rise in cosmetic tourism and the lag time between PMMA injection and development of hypercalcemia (mean time to presentation of 7 years), this complication is likely to become increasingly prevalent in North America. Presentation: Friday, June 16, 2023