Hypercalcemia Secondary to Silicone Inflammation Shown on FDG PET/CT

Area of Science:

• Medical Imaging
• Endocrinology
• Plastic Surgery

Background:

• Hypercalcemia is a common clinical finding associated with various systemic diseases, including malignancies and inflammatory processes.
• Free-silicone injections are used for cosmetic enhancement but can lead to complications.
• Granulomatous inflammation is a recognized response to foreign materials, including silicone.

Purpose of the Study:

• To report a case where FDG-PET/CT imaging was instrumental in diagnosing granulomatous inflammation secondary to cosmetic free-silicone injections.
• To highlight an unusual cause of hypercalcemia in a transgender patient.

Main Methods:

• A case presentation of a 43-year-old transgender woman hospitalized with respiratory distress and hypercalcemia.
• Utilized Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) for diagnostic imaging.
• Correlated imaging findings with the patient's history of cosmetic free-silicone injections.

Main Results:

• FDG-PET/CT demonstrated diffuse abnormal FDG uptake in the subcutaneous tissues of the gluteal regions and upper thighs.
• The abnormal uptake corresponded precisely to the areas of previous free-silicone injections.
• The findings suggested active granulomatous inflammation at the injection sites.

Conclusions:

• FDG-PET/CT can effectively identify inflammatory processes, such as granulomatous inflammation, in subcutaneous tissues.
• Cosmetic free-silicone injections can lead to delayed complications, including hypercalcemia due to inflammation.
• This case underscores the importance of considering iatrogenic causes for hypercalcemia and utilizing advanced imaging for diagnosis.