Negri Armando Luis, Rosa Diez Guillermo, Del Valle Elisa, Piulats Elsa, Greloni Gustavo, Quevedo Alejandra, Varela Federico, Diehl Maria, Bevione Pablo
Instituto de Investigaciones Metabólicas, Universidad del Salvador, Buenos Aires, Argentina.
Servicio de Nefrología, Hospital Italiano de Buenos Aires, Argentina.
Clin Cases Miner Bone Metab. 2014 Jan;11(1):44-8.
Association of dysregulated calcium homeostasis and granulomatous disease is well established. There exist reports in the literature of granulomatous reactions produced by silicones associated with hypercalcemia. In this case series we report four young women that underwent methacrylate injections in gluteus, thighs and calves that developed granulomas with posterior appearance of hypercalcemia. This complication presented as subacute around 6 months after the procedure. The four patients have as common elements the presence of moderate to severe renal insufficiency, suppressed PTH and elevated calcitriol levels for the degree of renal function. In the image studies, two patients presented in the nuclear magnetic resonance of the gluteus hypodense nodular images compatible with granulomas. Two patients had a positron emission tomography performed showing increased metabolic activity in the muscles of the gluteal region compatible with granulomas. Two patients had a partial surgical resection of the gluteal lesions with the finding of methacrylate associated to foreign body granulomas. In these patients hypercalcemia was treated with oral or local injections of corticoids, intravenous bisphosphonates or ketoconazole with good response. Although the prevalence of this complication with methacrylate injection is not common, hypercalcemia secondary to granulomas should be considered in the differential diagnosis of patients with hypercalcemia when there is a history of this procedure, and especially if they have a reduction in their renal function.
钙稳态失调与肉芽肿性疾病之间的关联已得到充分证实。文献中有关于与高钙血症相关的硅酮引起肉芽肿反应的报道。在本病例系列中，我们报告了四名年轻女性，她们在臀部、大腿和小腿接受了甲基丙烯酸酯注射，随后出现肉芽肿并伴有高钙血症。这种并发症在注射后约6个月时呈亚急性出现。这四名患者的共同特征是存在中度至重度肾功能不全，甲状旁腺激素（PTH）受抑制，且根据肾功能程度，骨化三醇水平升高。在影像学检查中，两名患者的臀部核磁共振显示低密度结节图像，与肉芽肿相符。两名患者进行了正电子发射断层扫描，显示臀肌区域肌肉代谢活性增加，与肉芽肿相符。两名患者对臀部病变进行了部分手术切除，发现甲基丙烯酸酯与异物肉芽肿有关。在这些患者中，高钙血症通过口服或局部注射皮质类固醇、静脉注射双膦酸盐或酮康唑进行治疗，效果良好。虽然甲基丙烯酸酯注射导致这种并发症的发生率并不常见，但当高钙血症患者有该手术史，尤其是肾功能减退时，在鉴别诊断中应考虑肉芽肿继发的高钙血症。
