Alimoradi Mersad, Chahal Ahmad, El-Rassi Elie, Daher Karim, Sakr Gazy
Lebanese University, Faculty of Medical Sciences, Department of General Surgery, Lebanon.
Lebanese University, Faculty of Medical Sciences, Department of Radiology, Lebanon.
Ann Med Surg (Lond). 2021 Sep 3;69:102771. doi: 10.1016/j.amsu.2021.102771. eCollection 2021 Sep.
Synthol injection for body contouring has been used by bodybuilders for some time. We report two extremely rare systemic complications; pulmonary granulomatosis and hypercalcemia, in a woman who has received Synthol injections for buttocks augmentation.
The case discussed in this report is of a 36-year-old lady who presented for severe hypercalcemia and nephrocalcinosis. Subsequent workup revealed granulomas in the buttocks and in the lungs. Upon questioning, it was discovered that she had received Synthol injection for buttocks augmentation a few months earlier. Labs were consistent with calcitriol mediated hypercalcemia, a phenomenon observed in granulomatous diseases. A diagnosis of foreign body granulomatosis with pulmonary migration and secondary hypercalcemia was made. The patient was started on prednisone and showed an initial positive response.
Reported complications of Synthol include pain, muscle deformity, and ulceration at the injection site. Hypercalcemia secondary to foreign body granulomatosis after Synthol injection has been reported only once previously, and here we report a second case. The hypercalcemia is thought to be calcitriol mediated, where overexpression of CYP27B1 in the macrophages forming the granulomas leads to pathological extrarenal calcitriol production. Pulmonary granulomatosis, theorized to be secondary to hematologic migration of the injected material, has never been reported previously with Synthol use.
Synthol injection for body contouring may be a cause of extensive local and pulmonary foreign body granulomatosis leading to calcitriol mediated hypercalcemia. History of cosmetic injections should not be disregarded during history taking.
合成醇注射用于身体塑形已被健美运动员使用了一段时间。我们报告了两例极其罕见的全身并发症；一名接受合成醇臀部填充注射的女性出现了肺肉芽肿病和高钙血症。
本报告中讨论的病例是一名36岁女性，因严重高钙血症和肾钙质沉着症就诊。随后的检查发现臀部和肺部有肉芽肿。经询问，发现她几个月前接受了合成醇臀部填充注射。实验室检查结果与肉芽肿病中观察到的维生素D介导的高钙血症一致。诊断为异物肉芽肿病伴肺部迁移和继发性高钙血症。患者开始使用泼尼松治疗，最初显示出阳性反应。
合成醇报告的并发症包括注射部位疼痛、肌肉畸形和溃疡。合成醇注射后异物肉芽肿继发高钙血症此前仅报告过一次，我们在此报告第二例。高钙血症被认为是由维生素D介导的，形成肉芽肿的巨噬细胞中CYP27B1的过度表达导致病理性肾外维生素D生成。理论上，肺肉芽肿病是注射物质血液迁移的继发结果，此前使用合成醇从未有过相关报告。
合成醇注射用于身体塑形可能是广泛局部和肺部异物肉芽肿病的原因，导致维生素D介导的高钙血症。在问诊时不应忽视美容注射史。
