C HOONG SONG1, V ENG PHUI1, H SIENG FLORENCE TAN2, H HONG CLARE TAN1
1Nephrology Unit, Sarawak General Hospital, Kuching, Malaysia, 2Endocrinology Unit, Sarawak General Hospital, Kuching, Malaysia
Background: Hypercalcemia is a relatively common clinical problem with 90% of the cases caused by primary hyperparathyroidism and malignancy. Hypercalcemia due to silicon-induced granulomatous reaction is rare. We report a case of hypercalcemia secondary to silicon-induced granulomatous reaction.
Case Report: A 62-year-old lady, known Hepatitis B carrier, with history of silicon oil globules injection at chin and bilateral breasts more than 15 years ago presented in December 2016 with pruritic, nodular skin lesions over the chin and both breasts without systemic symptoms. She was treated with four injections of dexamethasone over four months before proceeded with removal of breast tissues and implants in March 2017. Histopathological examination of the breasts showed rounded vacuoles consistent with silicon associated with foreign body giant cell reaction. A year later, she has recurrent admissions for symptomatic hypercalcemia, complicated by dehydration, renal insufficiency and depression requiring intravenous pamidronate and subcutaneous calcitonin. Various investigations including blood test and imaging studies were carried out to rule out common causes of hypercalcemia. There are no other causes of chronic kidney disease identified. A diagnosis of hypercalcemia secondary to silicon-induced granulomatous reaction was made. She was treated with oral prednisolone and her serum calcium level normalized. Her renal function improved from chronic kidney disease (CKD) stage 5 to CKD stage 4.
Conclusion: There should be high index of suspicion for silicon-induced granulomatous reaction as a cause of hypercalcemia in a patient with history of silicone implant or injection who came in with hypercalcemia and common causes for hypercalcemia excluded.
Dr. Song Chan Hoong is a Nephrology fellow currently based in Sarawak General Hospital, Kuching, Sarawak, Malaysia. He started his carrier as a medical doctor in 2011 and obtained his postgraduate qualification, MRCP (UK) in 2017. He joined Nephrology training program under Ministry of Health, Malaysia in 2020.