Synthol systemic complications: Hypercalcemia and pulmonary granulomatosis. A case report

Mersad Alimoradi; Ahmad Chahal; Elie El-Rassi; Karim Daher; Gazy Sakr

doi:10.1016/j.amsu.2021.102771

Synthol systemic complications: Hypercalcemia and pulmonary granulomatosis. A case report

Ann Med Surg (Lond). 2021 Sep 3:69:102771. doi: 10.1016/j.amsu.2021.102771. eCollection 2021 Sep.

Authors

Mersad Alimoradi¹, Ahmad Chahal², Elie El-Rassi³, Karim Daher³, Gazy Sakr⁴

Affiliations

¹ Lebanese University, Faculty of Medical Sciences, Department of General Surgery, Lebanon.
² Lebanese University, Faculty of Medical Sciences, Department of Radiology, Lebanon.
³ Lebanese American University, School of Medicine, Department of Urology, Lebanon.
⁴ Mount Lebanon Hospital, Department of Urology, Lebanon.

Abstract

Introduction: 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.

Presentation of case: 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.

Discussion: 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.

Conclusion: 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.

Keywords: Body contouring; CT, computed tomography; ESWL, extracorporeal shock wave lithotripsy; Fillers complication; Foreign body granulomatosis; Hypercalcemia; KUB, Kidney ureter bladder; Lung granuloma; Nephrocalcinosis; Nephrolithiasis; PET, positron emission tomography; PMMA, polymethylmethacrylate; PTH, parathyroid hormone; Synthol.

Publication types

Case Reports